Joint aspiration is a reliable tool for diagnosis of periprosthetic infection. There are different indications, techniques, and approaches for joint aspiration. We recommend that it be performed selectively when infection is suspected clinically. The specimens should be interpreted based on the results of the culture as well as the white cell count and differential. Specimen collection, transport, and analysis should be prompt to ensure yield accuracy.
BarrackRLJenningsRWWolfeMWBertotAJ. The Coventry Award. The value of preoperative aspiration before total knee revision. Clin Orthop Relat Res1997;345:8–16.
2.
O'NeillDAHarrisWH. Failed total hip replacement: Assessment by plain radiographs, arthrograms, and aspiration of the hip joint. J Bone Joint Surg Am1984;66:540–6.
3.
MurrayWRRodrigoJJ. Arthrography for the assessment of pain after total hip replacement. A comparison of arthrographic findings in patients with and without pain. J Bone Joint Surg Am1975;57:1060–5.
4.
BarrackRLHarrisWH. The value of aspiration of the hip joint before revision total hip arthroplasty. J Bone Joint Surg Am1993;75:66–76.
5.
VirolainenPLahteenmakiHHiltunenASipolaEMeurmanONelimarkkaO. The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg2002;91:178–81.
6.
FehringTKCohenB. Aspiration as a guide to sepsis in revision total hip arthroplasty. J Arthroplasty1996;11:543–7.
7.
AliFWilkinsonJMCooperJRKerryRMHamerAJNormanP. Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty. J Arthroplasty2006;21:221–6.
8.
LachiewiczPFRogersGDThomasonHC. Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture. J Bone Joint Surg Am1996;78:749–54.
9.
ValleDella CParviziJBauerTWDicesarePEEvansRPSegretiJ. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg2010;18:760–70.
10.
PhillipsWCKattapuramSV. Efficacy of preoperative hip aspiration performed in the radiology department. Clin Orthop Relat Res1983;179:141–6.
11.
RobertsPWaltersAJMcMinnDJ. Diagnosing infection in hip replacements. The use of fine-needle aspiration and radiometric culture. J Bone Joint Surg Br1992;74:265–9.
12.
CheungALachiewiczPFRennerJB. The role of aspiration and contrast-enhanced arthrography in evaluating the uncemented hip arthroplasty. AJR Am J Roentgenol1997;168:1305–9.
13.
LeopoldSSBattistaVOliverioJA. Safety and efficacy of intraarticular hip injection using anatomic landmarks. Clin Orthop Relat Res2001;391:192–7.
14.
ChewFSBrownJHPalmerWEKattapuramSV. CT-guided aspiration in potentially infected total hip replacements complicated by heterotopic bone. Eur J Radiol1995;20:72–4.
15.
KomppaGHNorthernJRSrHaasDKLiseckiEGhaedN. Ultrasound guidance for needle aspiration of the hip in patients with painful hip prosthesis. J Clin Ultrasound1985;13:433–4.
16.
FoldesKGaalMBalintPNemenyiKKissCBalintGP. Ultrasonography after hip arthroplasty. Skeletal Radiol1992;21:297–9.
17.
McCurdyWEMooreTEWalkerCW. The superolateral approach for aspiration of total hip arthroplasties. Australas Radiol2000;44:349–50.
18.
BrandserEAEl-KhouryGYFitzRandolphRL. Modified technique for fluid aspiration from the hip in patients with prosthetic hips. Radiology1997;204:580–2.
19.
SchmidtRMRosenkranzHS. Antimicrobial activity of local anaesthetics: Lidocaine and procaine. J Infect Dis1970;121:597–607.
20.
SpangehlMJMasriBAO'ConnellJXDuncanCP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am1999;81:672–83.
21.
TaylorTBeggsI. Fine needle aspiration in infected hip replacements. Clin Radiol1995;50:149–52.
22.
MalekzadehDOsmonDRLahrBDHanssenADBerbariEF. Prior use of antimicrobial therapy is a risk factor for culturenegative prosthetic joint infection. Clin Orthop Relat Res2010;468:2039–45.
23.
TrampuzAPiperKEJacobsonMJHanssenADUnniKKOsmonDR. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med2007;357:654–63.
24.
TrampuzAHanssenADOsmonDRMandrekarJSteckelbergJMPatelR. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med2004;117:556–62.
25.
ValleDella CJSporerSMJacobsJJBergerRARosenbergAGPaproskyWG. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty2007;22(6Suppl 2):90–3.
26.
GhanemEParviziJBurnettRSSharkeyPFKeshavarziNAggarwalA. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am2008;90:1637–43.
27.
BedairHTingNJacovidesCSaxenaAMoricMParviziJ. The Mark Coventry Award: Diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res2011;469:34–40.
28.
GhanemEHoussockCPulidoLHanSJaberiFMParviziJ. Determining “true” leukocytosis in bloody joint aspiration. J Arthroplasty2008;23:182–7.
29.
KerolusGClayburneGSchumacherHRJr. Is it mandatory to examine synovial fluids promptly after arthrocentesis?Arthritis Rheum1989;32:271–8.
30.
SalinasMRosasJIborraJManeroHPascualE. Comparison of manual and automated cell counts in EDTA preserved synovial fluids. Storage has little influence on the results. Ann Rheum Dis1997;56:622–6.
31.
ZadakaAGioeTGertnerE. Acute crystal-induced arthritis following arthroplasty. J Knee Surg2010;23:17–20.
32.
ArchibeckMJRosenbergAGSheinkopMBBergerRAJacobsJJ. Gout-induced arthropathy after total knee arthroplasty: A report of two cases. Clin Orthop Relat Res2001;392:377–82.
33.
CiprianoCABrownNMMichaelAMMoricMSporerSMValleDella CJ. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am2012;94:594–600.
34.
WilliamsJLNormanPStockleyI. The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery. J Arthroplasty2004;19:582–6.
35.
FinkBMakowiakCFuerstMBergerISchaferPFrommeltL. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br2008;90:874–8.
36.
WilsonMLWinnW. Laboratory diagnosis of bone, joint, soft-tissue, and skin infections. Clin Infect Dis2008;46:453–7.
37.
SchaferPFinkBSandowDMargullABergerIFrommeltL. Prolonged bacterial culture to identify late periprosthetic joint infection: A promising strategy. Clin Infect Dis2008;47:1403–9.
38.
von EssenRHolttaA. Improved method of isolating bacteria from joint fluids by the use of blood culture bottles. Ann Rheum Dis1986;45:454–7.
39.
von EssenR. Culture of joint specimens in bacterial arthritis. Impact of blood culture bottle utilization. Scand J Rheumatol1997;26:293–300.
40.
HughesJGVetterEAPatelRSchleckCDHarmsenSTurgeantLT. Culture with BACTEC Peds Plus/F bottle compared with conventional methods for detection of bacteria in synovial fluid. J Clin Microbiol2001;39:4468–71.
41.
FullerDDDavisTEKibseyPCRosmusLAyersLWOttM. Comparison of BACTEC Plus 26 and 27 media with and without fastidious organism supplement with conventional methods for culture of sterile body fluids. J Clin Microbiol1994;32:1488–91.
42.
ParviziJJacovidesCAntociVGhanemE. Diagnosis of periprosthetic joint infection: The utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am2011;93:2242–8.
