Andreas Hecker1, Anna Jungwirth-Weinberger2, Michael Robert Bauer2, Timo Tondelli2, Ilker Uçkay3, Karl Wieser2. 1. Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland. Electronic address: andreas.hecker@balgrist.ch. 2. Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland. 3. Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Department of Infectiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
Abstract
BACKGROUND: Shoulder joint aspirations are frequently performed to rule out infection. In case of unsuccessful aspiration, physicians often augment the aspiration liquid by injecting saline solution. METHODS: We performed shoulder joint aspirations by fluoroscopic assistance and analyzed the value of an additional saline solution irrigation in patients undergoing revision shoulder surgery. Native joints and post-fracture repair, post-arthroscopy, and post-arthroplasty shoulders were included. A minimum of 3 deep intraoperative tissue samples served as the microbiological gold standard. RESULTS: We performed 106 aspirations occurring between 0 and 179 days before revision surgery. Among them, we could sample intra-articular liquid directly in 60 cases and after saline solution injection in 43 cases, whereas 3 cases remained unsuccessful. According to intraoperative samples, 24 shoulders were infected but only 10 of 24 (42%) yielded pathogens in the aspirate. Moreover, of the 43 saline solution-enforced irrigations, none revealed bacteria but 8 (17%) confirmed infection in intraoperative samples. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of presurgical aspirations were 33%, 98%, 80%, and 83%, respectively. CONCLUSION: When surgical revision is planned, presurgical shoulder joint aspiration is not reliable to sufficiently exclude shoulder joint infection. Nevertheless, a positive aspiration finding can guide clinical decision making, so we propose to perform aspiration only if there is a clinically high index of suspicion for an infection. Irrigation after unsuccessful primary aspiration is futile.
BACKGROUND: Shoulder joint aspirations are frequently performed to rule out infection. In case of unsuccessful aspiration, physicians often augment the aspiration liquid by injecting saline solution. METHODS: We performed shoulder joint aspirations by fluoroscopic assistance and analyzed the value of an additional saline solution irrigation in patients undergoing revision shoulder surgery. Native joints and post-fracture repair, post-arthroscopy, and post-arthroplasty shoulders were included. A minimum of 3 deep intraoperative tissue samples served as the microbiological gold standard. RESULTS: We performed 106 aspirations occurring between 0 and 179 days before revision surgery. Among them, we could sample intra-articular liquid directly in 60 cases and after saline solution injection in 43 cases, whereas 3 cases remained unsuccessful. According to intraoperative samples, 24 shoulders were infected but only 10 of 24 (42%) yielded pathogens in the aspirate. Moreover, of the 43 saline solution-enforced irrigations, none revealed bacteria but 8 (17%) confirmed infection in intraoperative samples. Overall, the sensitivity, specificity, positive predictive value, and negative predictive value of presurgical aspirations were 33%, 98%, 80%, and 83%, respectively. CONCLUSION: When surgical revision is planned, presurgical shoulder joint aspiration is not reliable to sufficiently exclude shoulder joint infection. Nevertheless, a positive aspiration finding can guide clinical decision making, so we propose to perform aspiration only if there is a clinically high index of suspicion for an infection. Irrigation after unsuccessful primary aspiration is futile.
Authors: Julio J Jauregui; Andrew Tran; Samir Kaveeshwar; Vidushan Nadarajah; Moiuz W Chaudhri; R Frank Henn; Mohit N Gilotra; S Ashfaq Hasan Journal: J Orthop Date: 2021-07-13
Authors: Andreas Voss; Christian G Pfeifer; Maximilian Kerschbaum; Markus Rupp; Peter Angele; Volker Alt Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-03-23 Impact factor: 4.342