Novel approach: Ultrasound-guided periprosthetic biopsy in f
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A study was conducted to diagnose periprosthetic joint infection (PJI) preoperatively, and ultrasound-guided joint aspiration (US-JA) may not be performed when effusion is minimal or absent. The researchers wanted to report and examine the diagnostic output of ultrasound-guided periprosthetic biopsy (US-PB) of synovial tissue to obtain joint samples in patients with no fluid around the implants.

109 patients (55 males; mean age: 68±13 years) with failed total hip arthroplasty (THA) who underwent revision surgery performed pre-operative US-JA or US-PB to rule out PJI.

--69 out of 109 patients had joint effusion and underwent US-JA, while the remaining 40 with dry joint required US-PB.

--35 out of 109 patients (32.1%) had PJI, while 74/109 (67.9%) had aseptic THA failure.

--No immediate complications were observed in both groups. Technical success of US-PB was 100%, as the procedure was carried on as planned in all cases.

--Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-JA were 52.2%, 97.8%, 92.3%, 80.3%, and 82.6%, while for US-PB they were 41.7%, 100%, 100%, 80%, and 82.5%, respectively, with no significant difference.

--Using the final diagnosis as reference standard, a moderate agreement was observed with both US-JA (k=0.56) and US-PB (k=0.50).

Finally, a novel US-guided technique was proposed for biopsying periprosthetic synovial tissue from failed THAs to rule out PJI. The diagnostic performance was found to be equivalent as compared to traditional US-JA. This gives credence to further research into this procedure, which could be used in patients who do not have joint effusion.