Role of joint aspiration before re-implantation in patients with a cement spacer in place

doi:10.5312/wjo.v13.i6.615

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World Journal of Orthopedics

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Retrospective Study

World J Orthop. Jun 18, 2022; 13(6): 615-621
Published online Jun 18, 2022. doi: 10.5312/wjo.v13.i6.615

Role of joint aspiration before re-implantation in patients with a cement spacer in place

Sandra Huguet, Martí Bernaus, Lucía Gómez, Eva Cuchí, Alex Soriano, Lluís Font-Vizcarra

Sandra Huguet, Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain

Sandra Huguet, Department of Traumatology and Orthopaedics, Consorci Sanitari de l’Alt Penedès - Garraf, Vilafranca del Penedès 08720, Spain

Martí Bernaus, Lluís Font-Vizcarra, Department of Traumatology and Orthopaedics, Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain

Lucía Gómez, Eva Cuchí, Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain

Eva Cuchí, Department of Microbiology, CATLAB, Viladecavalls 08232, Spain

Alex Soriano, Department of Infectious Diseases, Osteoarticular Infections Unit, Hospital Clínic, Barcelona 08036, Spain

Author contributions: Huguet S wrote this manuscript; Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, and Font-Vizcarra L commented on previous versions of the manuscript; All authors read and approved the final manuscript.

Institutional review board statement: The study was reviewed and approved by the Mútua Terrassa Institutional Review Board.

Informed consent statement: No written consent was needed for this article. No identifying information is included in this article.

Conflict-of-interest statement: No conflict of interest.

Data sharing statement: No additional data are available.

Corresponding author: Sandra Huguet, MD, Surgeon, Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, Terrassa 08221, Spain. sahuguet@csap.cat

Received: December 27, 2021
Peer-review started: December 27, 2021
First decision: January 25, 2022
Revised: April 4, 2022
Accepted: May 13, 2022
Article in press: May 13, 2022
Published online: June 18, 2022
Processing time: 171 Days and 9.9 Hours

Abstract

BACKGROUND

The usefulness of a mandatory joint aspiration before re-implantation in patients with a cement spacer already in place is unclear.

AIM

To evaluate the role of culturing synovial fluid obtained by joint aspiration before re-implantation in patients who underwent a two-stage septic revision.

METHODS

A retrospective observational study was conducted, including patients that underwent a two-stage septic revision (hip or knee) from 2010 to 2017. After the first stage revision and according to intraoperative culture results, all patients were treated with an antibiotic protocol for 6-8 wk. Following 2 wk without antibiotics, a culture of synovial fluid was obtained. The results of these cultures were recorded and compared with cultures obtained during re-implantation surgery.

RESULTS

Forty-one patients (20 hip and 21 knee spacers) were included in the final analysis. In 39 cases, the culture of synovial fluid was negative, while in the remaining 2 cases (knee spacers) no analysis was possible due to dry tap. In 5 of the patients, two or more intraoperative cultures taken during the re-implantation surgery were positive.

CONCLUSION

We found no evidence to support mandatory joint aspiration before re-implantation in patients with a cement spacer in place.

Keywords: Joint aspiration; Synovial fluid; Two-stage surgery; Revision surgery; Periprosthetic joint infection

Core Tip: Many parameters and diagnostic methods have been analyzed to determine the optimal time to perform the second stage of a two-staged revision surgery. Synovial fluid culture after joint aspiration seems to be a reasonable test to evaluate the presence of microorganisms in the joint. However, the effectiveness of this diagnostic test is unclear. Despite the lack of validation, synovial aspiration is a common practice before prosthesis reimplantation. With our results, we found no evidence to support mandatory joint aspiration before re-implantation in patients with a cement spacer in place.