Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of joint aspiration before re-implantation in patients with a cement spacer in place. World J Orthop 2022; 13(6): 615-621 [PMID: 35949711 DOI: 10.5312/wjo.v13.i6.615]
Corresponding Author of This Article
Sandra Huguet, MD, Surgeon, Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Plaça del Doctor Robert, 5, Terrassa 08221, Spain. sahuguet@csap.cat
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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.
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.
