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The Journal of Bone and Joint Surgery, Vol 75, Issue 1 66-76, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
The value of aspiration of the hip joint before revision total hip arthroplasty
RL Barrack and WH Harris
Orthopaedic Biomechanics Laboratory, Massachusetts General Hospital, Boston 02114.
The role of aspiration of the hip joint before revision of a total hip
arthroplasty remains controversial. To address this issue, we reviewed the
results of 270 consecutive hips in which aspiration had been attempted
before revision procedures that were performed between 1980 and 1988. All
hips had intraoperative findings and clinical follow-up of at least two
years to confirm the presence or absence of infection. Only six (2 per
cent) of the 270 hips were determined to be infected. Aspiration had been
attempted in all six hips, but fluid could be obtained from only four. All
six hips also had clinical or radiographic signs, or both, of infection,
including increasing pain within three years after the arthroplasty (four
hips), inability of the patient to attain pain-free status after the
original procedure (four hips), radiographic findings compatible with
infection (six hips), and a positive finding on culture of a specimen
obtained from a previous aspiration (two hips). Because of these factors,
aspiration was attempted a second time in four of the six hips and a third
time in three of the four. The four hips from which fluid could be obtained
had a total of ten successful aspirations; the cultures of specimens
obtained from six of these procedures were positive and those from four
were negative. The appearance of the capsular tissue at the time of the
operation suggested infection in five of the six infected hips.
Histological sections were positive for inflammation in all six: there was
acute inflammation only in one, chronic inflammation only in two, and acute
and chronic inflammation in three. No organisms were seen on gram stains of
specimens from any of the six infected hips. Of the 254 hips that did not
have an infection and had been aspirated successfully, thirty-two (13 per
cent) had a false-positive result on culture of a specimen of the
aspiration fluid. Only two (6 per cent) of the thirty-four hips that had a
positive result on culture of fluid from the initial aspiration had a
true-positive result. No hip had a true-positive result on culture of fluid
that had been aspirated preoperatively without also having clinical and
radiographic evidence of infection. On the basis of these findings, we
recommend that aspiration be performed in selected patients rather than
routinely. It also should be performed only if a detailed clinical history
suggests infection or if radiographs demonstrate focal lysis, aggressive
non-focal lysis, or periostitis.
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