Imaging approach to prosthetic joint infection.
Arthroplasty
Image-guided joint aspiration
MRI
Prosthetic joint infection (PJI)
Journal
Skeletal radiology
ISSN: 1432-2161
Titre abrégé: Skeletal Radiol
Pays: Germany
ID NLM: 7701953
Informations de publication
Date de publication:
22 Dec 2023
22 Dec 2023
Historique:
received:
01
08
2023
accepted:
07
12
2023
revised:
08
10
2023
medline:
22
12
2023
pubmed:
22
12
2023
entrez:
22
12
2023
Statut:
aheadofprint
Résumé
The diagnosis of prosthetic joint infection (PJI) remains challenging, despite multiple available laboratory tests for both serum and synovial fluid analysis. The clinical symptoms of PJI are not always characteristic, particularly in the chronic phase, and there is often significant overlap in symptoms with non-infectious forms of arthroplasty failure. Further exacerbating this challenge is lack of a universally accepted definition for PJI, with publications from multiple professional societies citing different diagnostic criteria. While not included in many of the major societies' guidelines for diagnosis of PJI, diagnostic imaging can play an important role in the workup of suspected PJI. In this article, we will review an approach to diagnostic imaging modalities (radiography, ultrasound, CT, MRI) in the workup of suspected PJI, with special attention to the limitations and benefits of each modality. We will also discuss the role that image-guided interventions play in the workup of these patients, through ultrasound and fluoroscopically guided joint aspirations. While there is no standard imaging algorithm that can universally applied to all patients with suspected PJI, we will discuss a general approach to diagnostic imaging and image-guided intervention in this clinical scenario.
Identifiants
pubmed: 38133670
doi: 10.1007/s00256-023-04546-7
pii: 10.1007/s00256-023-04546-7
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to International Skeletal Society (ISS).
Références
Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am. 2015;97:1386–97.
pubmed: 26333733
doi: 10.2106/JBJS.N.01141
Singh JA, Yu S, Chen L, Cleveland JD. Rates of total joint replacement in the United States: future projections to 2020-2040 using the national inpatient sample. J Rheumatol. 2019;46:1134–40.
pubmed: 30988126
doi: 10.3899/jrheum.170990
Tubb CC, Polkowksi GG, Krause B. Diagnosis and prevention of periprosthetic joint infections. J Am Acad Orthop Surg. 2020;28:e340–8.
pubmed: 31972719
doi: 10.5435/JAAOS-D-19-00405
Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33:1309–1314.e2.
pubmed: 29551303
doi: 10.1016/j.arth.2018.02.078
Romanò CL, Petrosillo N, Argento G, Sconfienza LM, Treglia G, Alavi A, et al. The role of imaging techniques to define a peri-prosthetic hip and knee joint infection: multidisciplinary consensus statements. J Clin Med. 2020;9:2548.
pubmed: 32781651
pmcid: 7466174
doi: 10.3390/jcm9082548
Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, et al. diagnosis and management of prosthetic joint infection: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:e1–25.
pubmed: 23223583
doi: 10.1093/cid/cis803
Renz N, Yermak K, Perka C, Trampuz A. Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection: not a screening but a confirmatory test. J Bone Jt Surg. 2018;100:742–50.
doi: 10.2106/JBJS.17.01005
Romanò CL, Khawashki HA, Benzakour T, Bozhkova S, Del Sel H, Hafez M, et al. The W.A.I.O.T. definition of high-grade and low-grade peri-prosthetic joint infection. J Clin Med. 2019;8:650.
pubmed: 31083439
pmcid: 6571975
doi: 10.3390/jcm8050650
Parvizi J, Gehrke T. Proceedings of the second international consensus meeting on musculoskeletal infection. Data Trace Publishing Company; 2018.
Parvizi J, Gehrke T. International consensus group on periprosthetic joint infection. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29:1331.
pubmed: 24768547
doi: 10.1016/j.arth.2014.03.009
Signore A, Sconfienza LM, Borens O, Glaudemans AWJM, Cassar-Pullicino V, Trampuz A, et al. Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. 2019;46:971–88.
pubmed: 30683987
pmcid: 6450843
doi: 10.1007/s00259-019-4263-9
Sconfienza LM, Signore A, Cassar-Pullicino V, Cataldo MA, Gheysens O, Borens O, et al. Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur Radiol. 2019;29:6425–38.
pubmed: 31250170
doi: 10.1007/s00330-019-06326-1
Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, et al. ACR Appropriateness Criteria ® imaging after total knee arthroplasty. J Am Coll Radiol. 2017;14:S421–48.
pubmed: 29101982
doi: 10.1016/j.jacr.2017.08.036
Thejeel B, Endo Y. Imaging of total hip arthroplasty: part II – imaging of component dislocation, loosening, infection, and soft tissue injury. Clin Imaging. 2022;92:72–82.
pubmed: 36240524
doi: 10.1016/j.clinimag.2022.09.011
Harmer JL, Pickard J, Stinchcombe SJ. The role of diagnostic imaging in the evaluation of suspected osteomyelitis in the foot: a critical review. The Foot. 2011;21:149–53.
pubmed: 21636263
doi: 10.1016/j.foot.2010.11.005
Walde TA, Weiland DE, Leung SB, Kitamura N, Sychterz CJ, Engh CA, et al. Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis: a cadaveric study. Clin Orthop. 2005;NA:138–44.
doi: 10.1097/01.blo.0000164028.14504.46
Cyteval C, Hamm V, Sarrabère MP, Lopez FM, Maury P, Taourel P. Painful infection at the site of hip prosthesis: CT imaging. Radiology. 2002;224:477–83.
pubmed: 12147845
doi: 10.1148/radiol.2242010989
Miller TT. Imaging of hip arthroplasty. Eur J Radiol. 2012;81:3802–12.
pubmed: 21530121
doi: 10.1016/j.ejrad.2011.03.103
van Holsbeeck MT, Eyler WR, Sherman LS, Lombardi TJ, Mezger E, Verner JJ, et al. Detection of infection in loosened hip prostheses: efficacy of sonography. AJR Am J Roentgenol. 1994;163:381–4.
pubmed: 8037036
doi: 10.2214/ajr.163.2.8037036
Li N, Kagan R, Hanrahan CJ, Hansford BG. Radiographic evidence of soft-tissue gas 14 days after total knee arthroplasty is predictive of early prosthetic joint infection. Am J Roentgenol. 2020;214:171–6.
doi: 10.2214/AJR.19.21702
Expert Panel on Musculoskeletal Imaging, Weissman BN, Palestro CJ, Fox MG, Bell AM, Blankenbaker DG et al. ACR Appropriateness Criteria® imaging after total hip arthroplasty. J Am Coll Radiol. 2023;20:S413–32.
Klauser AS, Tagliafico A, Allen GM, Boutry N, Campbell R, Court-Payen M, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European society of musculoskeletal radiology. Eur Radiol. 2012;22:1140–8.
pubmed: 22453857
doi: 10.1007/s00330-011-2356-3
Soliman SB, Davis JJ, Muh SJ, Vohra ST, Patel A, van Holsbeeck MT. Ultrasound evaluations and guided procedures of the painful joint arthroplasty. Skeletal Radiol. 2022;51:2105–20.
pubmed: 35624311
doi: 10.1007/s00256-022-04080-y
Craig JG. Ultrasound of the postoperative hip. Semin Musculoskelet Radiol. 2013;17:49–55.
pubmed: 23487334
doi: 10.1055/s-0033-1333914
Weybright PN, Jacobson JA, Murry KH, Lin J, Fessell DP, Jamadar DA, et al. Limited effectiveness of sonography in revealing hip joint effusion: preliminary results in 21 adult patients with native and postoperative hips. Am J Roentgenol. 2003;181:215–8.
doi: 10.2214/ajr.181.1.1810215
Douis H, Dunlop DJ, Pearson AM, O’Hara JN, James SLJ. The role of ultrasound in the assessment of post-operative complications following hip arthroplasty. Skeletal Radiol. 2012;41:1035–46.
pubmed: 22426776
doi: 10.1007/s00256-012-1390-9
Math KR, Berkowitz JL, Paget SA, Endo Y. Imaging of musculoskeletal infection. Rheum Dis Clin North Am. 2016;42:769–84.
pubmed: 27742026
doi: 10.1016/j.rdc.2016.07.010
Reish TG, Clarke HD, Scuderi GR, Math KR, Scott WN. Use of multi-detector computed tomography for the detection of periprosthetic osteolysis in total knee arthroplasty. J Knee Surg. 2006;19:259–64.
pubmed: 17080648
doi: 10.1055/s-0030-1248116
Isern-Kebschull J, Tomas X, García-Díez AI, Morata L, Ríos J, Soriano A. Accuracy of computed tomography–guided joint aspiration and computed tomography findings for prediction of infected hip prosthesis. J Arthroplasty. 2019;34:1776–82.
pubmed: 31056444
doi: 10.1016/j.arth.2019.04.018
Taljanovic MS, Gimber LH, Omar IM, Klauser AS, Miller MD, Wild JR, et al. Imaging of postoperative infection at the knee joint. Semin Musculoskelet Radiol. 2018;22:464–80.
pubmed: 30134470
doi: 10.1055/s-0038-1667119
Wellenberg RHH, Hakvoort ET, Slump CH, Boomsma MF, Maas M, Streekstra GJ. Metal artifact reduction techniques in musculoskeletal CT-imaging. Eur J Radiol. 2018;107:60–9.
pubmed: 30292274
doi: 10.1016/j.ejrad.2018.08.010
Katsura M, Sato J, Akahane M, Kunimatsu A, Abe O. Current and novel techniques for metal artifact reduction at CT: practical guide for radiologists. RadioGraphics. 2018;38:450–61.
pubmed: 29528826
doi: 10.1148/rg.2018170102
Huang JY, Kerns JR, Nute JL, Liu X, Balter PA, Stingo FC, et al. An evaluation of three commercially available metal artifact reduction methods for CT imaging. Phys Med Biol. 2015;60:1047–67.
pubmed: 25585685
pmcid: 4311882
doi: 10.1088/0031-9155/60/3/1047
Andersson KM, Norrman E, Geijer H, Krauss W, Cao Y, Jendeberg J, et al. Visual grading evaluation of commercially available metal artefact reduction techniques in hip prosthesis computed tomography. Br J Radiol. 2016;89:20150993.
pubmed: 27123700
doi: 10.1259/bjr.20150993
Pessis E, Sverzut J-M, Campagna R, Guerini H, Feydy A, Drapé J-L. Reduction of metal artifact with dual-energy CT: virtual monospectral imaging with fast kilovoltage switching and metal artifact reduction software. Semin Musculoskelet Radiol. 2015;19:446–55.
pubmed: 26696083
doi: 10.1055/s-0035-1569256
Khodarahmi I, Fishman E, Fritz J. Dedicated CT and MRI techniques for the evaluation of the postoperative knee. Semin Musculoskelet Radiol. 2018;22:444–56.
pubmed: 30134468
doi: 10.1055/s-0038-1653955
Huang Z, Zhang G, Lin J, Pang Y, Wang H, Bai T, et al. Multi-modal feature-fusion for CT metal artifact reduction using edge-enhanced generative adversarial networks. Comput Methods Programs Biomed. 2022;217:106700.
pubmed: 35228146
doi: 10.1016/j.cmpb.2022.106700
Schwaiger BJ, Gassert FT, Suren C, Gersing AS, Haller B, Pfeiffer D, et al. Diagnostic accuracy of MRI with metal artifact reduction for the detection of periprosthetic joint infection and aseptic loosening of total hip arthroplasty. Eur J Radiol. 2020;131:109253.
pubmed: 32937252
doi: 10.1016/j.ejrad.2020.109253
Goodman SB, Gallo J. Periprosthetic osteolysis: mechanisms, prevention and treatment. J Clin Med. 2019;8:2091.
pubmed: 31805704
pmcid: 6947309
doi: 10.3390/jcm8122091
Plodkowski AJ, Hayter CL, Miller TT, Nguyen JT, Potter HG. Lamellated hyperintense synovitis: potential MR imaging sign of an infected knee arthroplasty. Radiology. 2013;266:256–60.
pubmed: 23091176
doi: 10.1148/radiol.12120042
Gao Z, Jin Y, Chen X, Dai Z, Qiang S, Guan S, et al. Diagnostic value of MRI lamellated hyperintense synovitis in periprosthetic infection of hip. Orthop Surg. 2020;12:1941–6.
pubmed: 33225607
pmcid: 7767676
doi: 10.1111/os.12789
Fritz J, Meshram P, Stern SE, Fritz B, Srikumaran U, McFarland EG. Diagnostic performance of advanced metal artifact reduction MRI for periprosthetic shoulder infection. J Bone Jt Surg. 2022;104:1352–61.
doi: 10.2106/JBJS.21.00912
Jiang M, He C, Feng J, Li Z, Chen Z, Yan F, et al. Magnetic resonance imaging parameter optimizations for diagnosis of periprosthetic infection and tumor recurrence in artificial joint replacement patients. Sci Rep. 2016;6:36995.
pubmed: 27841342
pmcid: 5107991
doi: 10.1038/srep36995
Galley J, Sutter R, Stern C, Filli L, Rahm S, Pfirrmann CWA. Diagnosis of periprosthetic hip joint infection using MRI with metal artifact reduction at 1.5 T. radiology. 2020;296:98–108.
pubmed: 32396046
doi: 10.1148/radiol.2020191901
Fritz J, Lurie B, Miller TT, Potter HG. MR imaging of hip arthroplasty implants. RadioGraphics. 2014;34:E106–32.
pubmed: 25019450
doi: 10.1148/rg.344140010
Berkowitz JL, Potter HG. Advanced MRI techniques for the hip joint: focus on the postoperative hip. Am J Roentgenol. 2017;209:534–43.
doi: 10.2214/AJR.16.17789
Khodarahmi I, Khanuja HS, Stern SE, Carrino JA, Fritz J. Compressed Sensing SEMAC MRI of hip, knee, and ankle arthroplasty implants: A 1.5-T and 3-T intrapatient performance comparison for diagnosing periprosthetic abnormalities. AJR Am J Roentgenol. 2023;221:661–72.
Fritz J, Lurie B, Potter HG. MR imaging of knee arthroplasty implants. Radiogr Rev Publ Radiol Soc N Am Inc. 2015;35:1483–501.
Murthy S, Fritz J. Metal artifact reduction MRI in the diagnosis of periprosthetic hip joint infection. Radiology. 2023;306:e220134.
pubmed: 36318029
doi: 10.1148/radiol.220134
Choi S-J, Koch KM, Hargreaves BA, Stevens KJ, Gold GE. Metal artifact reduction with MAVRIC SL at 3-T MRI in patients with hip arthroplasty. AJR Am J Roentgenol. 2015;204:140–7.
pubmed: 25539249
pmcid: 4321802
doi: 10.2214/AJR.13.11785
Khodarahmi I, Nittka M, Fritz J. Leaps in technology: advanced MR imaging after total hip arthroplasty. Semin Musculoskelet Radiol. 2017;21:604–15.
pubmed: 29025189
doi: 10.1055/s-0037-1606135
Shahi A, Tan TL, Kheir MM, Tan DD, Parvizi J. Diagnosing periprosthetic joint infection: and the winner is? J Arthroplasty. 2017;32:S232–5.
pubmed: 28712799
doi: 10.1016/j.arth.2017.06.005
Carli AV, Abdelbary H, Ahmadzai N, Cheng W, Shea B, Hutton B, et al. Diagnostic accuracy of serum, synovial, and tissue testing for chronic periprosthetic joint infection after hip and knee replacements: a systematic review. J Bone Jt Surg. 2019;101:635–49.
doi: 10.2106/JBJS.18.00632
Lee YS, Koo K-H, Kim HJ, Tian S, Kim T-Y, Maltenfort MG, et al. Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Jt Surg. 2017;99:2077–84.
doi: 10.2106/JBJS.17.00123
Bonanzinga T, Ferrari MC, Tanzi G, Vandenbulcke F, Zahar A, Marcacci M. The role of alpha defensin in prosthetic joint infection (PJI) diagnosis: a literature review. EFORT Open Rev. 2019;4:10–3.
pubmed: 30800475
pmcid: 6362339
doi: 10.1302/2058-5241.4.180029
Partridge DG, Winnard C, Townsend R, Cooper R, Stockley I. Joint aspiration, including culture of reaspirated saline after a “dry tap”, is sensitive and specific for the diagnosis of hip and knee prosthetic joint infection. Bone Joint J. 2018;100-B:749–54.
Kanthawang T, Bodden J, Joseph GB, Vail T, Ward D, Patel R, et al. Diagnostic value of fluoroscopy-guided hip aspiration for periprosthetic joint infection. Skeletal Radiol. 2021;50:2245–54.
pubmed: 33956170
doi: 10.1007/s00256-021-03795-8
Li M, Zeng Y, Wu Y, Si H, Bao X, Shen B. Performance of sequencing assays in diagnosis of prosthetic joint infection: a systematic review and meta-analysis. J Arthroplasty. 2019;34:1514–1522.e4.
pubmed: 31005434
doi: 10.1016/j.arth.2019.02.044
Flierl MA, Sobh AH, Culp BM, Baker EA, Sporer SM. Evaluation of the painful total knee arthroplasty. J Am Acad Orthop Surg. 2019;27:743–51.
pubmed: 31008874
doi: 10.5435/JAAOS-D-18-00083
Hao L, Wen P, Song W, Zhang B, Wu Y, Zhang Y, et al. Direct detection and identification of periprosthetic joint infection pathogens by metagenomic next-generation sequencing. Sci Rep. 2023;13:7897.
pubmed: 37193765
pmcid: 10188433
doi: 10.1038/s41598-023-35215-3
Della Valle C, Parvizi J, Bauer TW, DiCesare PE, Evans RP, Segreti J, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am. 2011;93:1355–7.
pubmed: 21792503
doi: 10.2106/JBJS.9314ebo
Abdel Karim M, Andrawis J, Bengoa F, Bracho C, Compagnoni R, Cross M, et al. Hip and knee section, diagnosis, algorithm: proceedings of international consensus on orthopedic infections. J Arthroplasty. 2019;34:S339–50.
pubmed: 30348566
doi: 10.1016/j.arth.2018.09.018
Staphorst F, Jutte PC, Boerboom AL, Kampinga GA, Ploegmakers JJW, Wouthuyzen-Bakker M. Should all hip and knee prosthetic joints be aspirated prior to revision surgery? Arch Orthop Trauma Surg. 2021;141:461–8.
pubmed: 33559723
pmcid: 7900020
doi: 10.1007/s00402-021-03791-6
Battaglia M, Vannini F, Guaraldi F, Rossi G, Biondi F, Sudanese A. Validity of preoperative ultrasound-guided aspiration in the revision of hip prosthesis. Ultrasound Med Biol. 2011;37:1977–83.
pubmed: 22036640
doi: 10.1016/j.ultrasmedbio.2011.09.004
Li X, Hirsch JA, Rehani MM, Yang K, Liu B. Effective dose assessment for patients undergoing contemporary fluoroscopically guided interventional procedures. Am J Roentgenol. 2020;214:158–70.
doi: 10.2214/AJR.19.21804
Yang K, Ganguli S, DeLorenzo MC, Zheng H, Li X, Liu B. Procedure-specific CT dose and utilization factors for CT-guided interventional procedures. Radiology. 2018;289:150–7.
pubmed: 30015583
doi: 10.1148/radiol.2018172945
Tomas X, Bori G, Garcia S, Garcia-Diez AI, Pomes J, Soriano A, et al. Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty. Skeletal Radiol. 2011;40:57–64.
pubmed: 20449586
doi: 10.1007/s00256-010-0940-2
Christensen TH, Ong J, Lin D, Aggarwal VK, Schwarzkopf R, Rozell JC. How does a “dry tap” impact the accuracy of preoperative aspiration results in predicting chronic periprosthetic joint infection? J Arthroplasty. 2022;37:925–9.
pubmed: 35114320
doi: 10.1016/j.arth.2022.01.066
Deirmengian C, Feeley S, Kazarian GS, Kardos K. Synovial fluid aspirates diluted with saline or blood reduce the sensitivity of traditional and contemporary synovial fluid biomarkers. Clin Orthop. 2020;478:1805–13.
pubmed: 32191417
pmcid: 7371050
doi: 10.1097/CORR.0000000000001188
Heckmann ND, Nahhas CR, Yang J, Della Valle CJ, Yi PH, Culvern CN, et al. Saline lavage after a “dry tap.” Bone Joint J. 2020;102-B:138–44.
Serfaty A, Jacobs A, Gyftopoulos S, Samim M. Likelihood of hip infection with image-guided hip aspiration dry tap: a 10-year retrospective study. Skeletal Radiol. 2022;51:1947–58.
pubmed: 35359220
doi: 10.1007/s00256-022-04046-0
Sconfienza LM, Albano D, Messina C, D’Apolito R, De Vecchi E, Zagra L. Ultrasound-guided periprosthetic biopsy in failed total hip arthroplasty: a novel approach to test infection in patients with dry joints. J Arthroplasty. 2021;36:2962–7.
pubmed: 33814266
doi: 10.1016/j.arth.2021.03.029
Cross MC, Kransdorf MJ, Chivers FS, Lorans R, Roberts CC, Schwartz AJ, et al. Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty. Skeletal Radiol. 2014;43:165–8.
pubmed: 24270975
doi: 10.1007/s00256-013-1757-6
Coiffier G, Ferreyra M, Albert J-D, Stock N, Jolivet-Gougeon A, Perdriger A, et al. Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department. Clin Rheumatol. 2018;37:2241–9.
pubmed: 29948353
doi: 10.1007/s10067-018-4160-9
Rajakulasingam R, Cleaver L, Khoo M, Pressney I, Upadhyay B, Palanivel S, et al. Introducing image-guided synovial aspiration and biopsy in assessing peri-prosthetic joint infection: an early single-centre experience. Skeletal Radiol. 2021;50:2031–40.
pubmed: 33825021
doi: 10.1007/s00256-021-03774-z