ArticleArchives of orthopaedic and trauma surgery2025
Diagnostic value of preoperative joint aspiration for periprosthetic shoulder infection: analysis of microbiological aspects and preoperative ICM minor criteria.
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 2 of them syntheses that pooled it.
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Who cites it
2 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Bacteriophages in Hip and Knee Periprosthetic Joint Infections: A Promising Tool in the Era of Antibiotic Resistance.Medical sciences (Basel, Switzerland) · 2025Pooled it
- The bacterial spectrum of spinal infections based on blood culture, tissue culture, and molecular methods: a systematic review and meta-analysis.Scientific reports · 2025Pooled it
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe incidence of shoulder arthroplasty (SA) has risen significantly and is expected to continue increasing. Periprosthetic shoulder infection (PSI), though rare, remains a major concern due to non-specific symptoms and low-virulent pathogens like Cutibacterium acnes. The diagnostic value of preoperative joint aspiration and the minor criteria of the 2018 International Consensus Meeting (ICM) for PSI diagnosis remains controversial, requiring further investigation. This study evaluates (1) the microbiological accuracy of standardized joint aspiration and (2) the predictive value of preoperative ICM minor criteria for PSI. MATERIAL AND
methodsA retrospective analysis was conducted on patients undergoing revision surgery after SA, where standardized joint aspiration was performed. Microbiological cultures, synovial fluid markers, and C-reactive protein levels were analyzed and compared to intraoperative biopsy cultures. Sufficient aspiration was defined as obtaining ≥ 1 ml of fluid and culture incubation for ≥ 14 days. Sensitivity, specificity, positive/negative predictive values, and accuracy were calculated. A receiver operating characteristic (ROC) analysis was performed for preoperative ICM criteria.
resultsOf 258 revisions, 235 met inclusion criteria. Cutibacterium acnes was the most frequently cultured pathogen. Joint aspiration showed 84.2% concordance with intraoperative tissue cultures, yielding 81% diagnostic accuracy. Among preoperative ICM minor criteria, white blood cell count/leukocyte esterase (WBC/LE) and alpha-defensin exhibited the highest accuracy (80-81%) for PSI detection. ROC analysis of the preoperative ICM model resulted in an AUC of 0.76.
conclusionsPreoperative joint aspiration following a standardized protocol demonstrates good diagnostic accuracy for PSI, with Cutibacterium acnes most commonly identified. The preoperative ICM 2018 minor criteria, particularly WBC/LE and alpha defensin, exhibit high accuracy for PSI detection. Therefore, diagnostic joint aspiration should be routinely considered, potentially avoiding more invasive diagnostic procedures. Nevertheless, a suspected aspiration without detection of germs should lead to further diagnostic steps. LEVEL OF EVIDENCE: Level III retrospective study.
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