The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: a systematic review

Abstract. Background: this systematic review aims to evaluate the concordance
between preoperative synovial fluid culture and intraoperative tissue
cultures in patients with periprosthetic joint infection (PJI) undergoing
total hip (THA) or knee arthroplasty (TKA) revision surgery.
Methods: this review was conducted in accordance with the preferred
reporting items for a systematic review and meta-analysis of diagnostic test
accuracy studies (PRISMA-DTA) statement. Cochrane, Embase,
PubMed, and Web of Science databases were searched to identify studies
involving patients who had THA or TKA revision surgery for PJI and for whom
preoperative synovial fluid culture and intraoperative tissue cultures were
performed. Studies were only included if the diagnosis of PJI was based on
the EBJIS (the European Bone and Joint Infection Society) or MSIS (Musculoskeletal Infection Society) criteria. Risk of bias was assessed using an amended
version of Joanna Briggs Institute's (JBI) critical appraisal checklist for
case series. Results: seven studies were included in this review
comprising 1677 patients. All studies had a retrospective study design and
five studies explored patients undergoing revision surgery of THA or TKA.
Concordance rates varied between 52 % and 79 %, but different authors
defined and calculated concordance differently. Six studies were judged as
having an unclear to high risk of bias and one study as having a low risk
of bias. Conclusions: the included studies showed a wide range of
concordance rates between preoperative synovial fluid culture and
intraoperative tissue cultures and the majority of studies had a high risk
of bias. Higher-quality studies are warranted to obtain a more accurate
estimate of this concordance rate. We recommend continuing the use of a
system such as the EBJIS definition or MSIS criteria when diagnosing PJI.
