ABSTRACT
Background: Total joint arthroplasties continue to increase as do periprosthetic joint infections (PJIs). Ultrasound-guided aspiration can yield useful synovial fluid for analysis while avoiding radiation exposure. This study presents a high-yield, ultrasound-guided technique with analysis of aspiration results. Methods: All consecutive ultrasound-guided aspirations of hip arthroplasties performed from May 2016 through to April 2019 were retrospectively reviewed. Patient demographic information, component specifics, presence of draining sinus, and inflammatory markers were recorded. Results of aspiration including volume, appearance, lavage use, synovial fluid differential leukocyte count, synovial neutrophil percent, and culture results were recorded. Surgical results, specimen cultures, and surgeon description of purulence were recorded. Aspiration results were compared to the surgical specimen results in all patients who underwent reoperations. Results: Review of 349 hip aspirations demonstrated accuracy of 87â¯%, sensitivity of 83â¯%, specificity of 89â¯%, positive predictive value of 79â¯%, and negative predictive value 91â¯%. Surgical and aspiration cultures matched in 81â¯% of cases. Bloody aspirates and aspirates obtained after lavage had less accuracy at 69â¯% and 60â¯%, respectively. Specificity was 100â¯% for cultures obtained with lavage and 91â¯% for bloody aspirates. Synovial leukocyte count and neutrophil percentage was obtained in 85â¯% of aspirations, and cultures were obtained in 98â¯% of aspirates. Contamination rate was 2â¯%. Conclusion: Ultrasound-guided aspirations aid in the diagnosis of PJI. The use of lavage to obtain fluid is helpful when aspiration cultures are positive. Bloody aspirates are less accurate but have high specificity. A low contamination rate and 88â¯% accuracy results with this meticulous technique.
Subject(s)
Rotator Cuff Injuries , Adolescent , Arthroscopy , Athletic Injuries/diagnostic imaging , Athletic Injuries/surgery , Child , Humans , Male , Radiography , Range of Motion, Articular , Rotator Cuff/diagnostic imaging , Rotator Cuff/surgery , Shoulder Injuries , Shoulder Joint/diagnostic imaging , Shoulder Joint/surgery , Shoulder Pain/diagnostic imaging , Shoulder Pain/surgery , Tendon Injuries/surgeryABSTRACT
Family violence, in the form of child abuse, adult domestic violence, and elder abuse, is a major public health problem in the United States. It leads to physical and psychological disability, loss of productivity, and even death. It can perpetuate itself through successive generations and contributes to the escalating costs of health care in this country. Family violence affects a significant proportion of the US population either as direct victims or as witnesses of abuse. As a result, orthopaedic surgeons are undoubtedly treating family violence victims, knowingly or unknowingly in their practices. Therefore, it is important that orthopaedic surgeons understand that victims of family violence often present for orthopaedic care in both emergency department and office or clinic settings. It is equally important that orthopaedic surgeons acquire the skills that are needed for the appropriate evaluation, diagnosis, treatment, and referral of such victims.