Repeat Hip Aspiration
We suggest a repeat hip aspiration when there is a discrepancy between the probability of periprosthetic joint infection and the initial aspiration culture result.
MODERATE RECOMMENDATION Rationale
A repeat hip aspiration is suggested when there is a discrepancy between the clinical probability of infection and the result of the initial aspiration culture.
One Level I study addressed this recommendation. This study examined performing a repeat hip aspiration in 28 patients because their initial aspiration result conflicted with the clinical suspicion for periprosthetic infection.4 This report suggests that repeat aspiration of the hip be considered when 1) the clinical probability of infection is low but the initial aspiration culture result is positive, or 2) if the clinical probability of infection is high and the initial aspiration culture result is negative (see Supporting Evidence below, for details).
The results of additional tests will raise or lower the probability of periprosthetic infection. The study on which this recommendation is based predated the more routine use and acceptance of synovial fluid white blood cell count and differential. Thus, depending on the results of the synovial fluid white blood cell count and differential, as well as the ESR and CRP, the diagnosis or exclusion of periprosthetic infection may be apparent and repeat aspiration may not be necessary.
One Level I study addressed this recommendation. This study examined performing a repeat hip aspiration in 28 patients because their initial aspiration result conflicted with the clinical suspicion for periprosthetic infection.4 This report suggests that repeat aspiration of the hip be considered when 1) the clinical probability of infection is low but the initial aspiration culture result is positive, or 2) if the clinical probability of infection is high and the initial aspiration culture result is negative (see Supporting Evidence below, for details).
The results of additional tests will raise or lower the probability of periprosthetic infection. The study on which this recommendation is based predated the more routine use and acceptance of synovial fluid white blood cell count and differential. Thus, depending on the results of the synovial fluid white blood cell count and differential, as well as the ESR and CRP, the diagnosis or exclusion of periprosthetic infection may be apparent and repeat aspiration may not be necessary.