ArticleActa orthopaedica2026
Ultrasound- and fluoroscopy-guided hip aspiration before revision total hip arthroplasty: procedural outcomes and diagnostic accuracy in sequential cohorts.
Article in Acta orthopaedica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background and purposeHip aspiration remains essential in the diagnostic work-up of a painful total hip arthroplasty (THA) to assess for periprosthetic joint infection (PJI). In 2020, our institution transitioned from fluoroscopy-guided to ultrasound-guided aspiration. Our study aimed to describe dry-tap proportions, aspirated volumes, and complications, and explore diagnostic accuracy in sequential cohorts.
methodsThis retrospective single-center study included 117 fluoroscopy-guided aspirations (December 2013-June 2020) and 90 ultrasound-guided aspirations (April 2020-March 2024) before revision THA. Procedural outcomes defined as dry taps, aspirated volumes, and complications within 14 days were assessed in the full cohorts, and diagnostic accuracy in procedures with a successful aspiration. Ultrasound-guided biopsy was performed in 39 patients.
resultsThe prevalence of PJI was 54/117 (46%) in the fluoroscopy cohort and 25/90 (28%) in the ultrasound cohort (difference -18 percentage points, 95% confidence interval [CI] -31 to -5). Dry taps occurred in 38/117 (32%) and 31/90 (34%) procedures, corresponding to an absolute difference of 2 percentage points (CI -11 to 16). Median aspirated volumes were 5 mL in the fluoroscopy cohort and 4 mL in the ultrasound cohort. No complications were recorded in the fluoroscopy cohort; 2 occurred in the ultrasound cohort, both among patients who underwent biopsy. Sensitivity was 16/34 (47%, CI 30-65) for fluoroscopy and 8/13 (62%, CI 32-86) for ultrasound; specificity was 41/44 (93%, CI 81-99) and 37/40 (93%, CI 80-98).
conclusionDry-tap proportions were similar in these sequential cohorts. 2 complications were recorded, both in patients who underwent biopsy. Specificity was high, whereas sensitivity could be assessed only in patients with a successful aspiration and available culture results, resulting in less precise estimates. The findings do not establish equivalence or superiority.
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