Accuracy of Preoperative Hip Aspiration in Diagnosing Infection Prior to Conversion to Total Hip Arthroplasty is Low

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Tehran university of medical scince

2 Tehran University of Medical Sciences Joint Reconstruction Research Center

3 Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

4 Joint reconstruction institude

5 Tehran university of medical sciences

6 Tehran University of Medical Sciences

10.22038/abjs.2025.82044.3732

Abstract

Background:

Proximal femoral fractures in the elderly often lead to total hip arthroplasty (cTHA) post-failure of open reduction and internal fixation (ORIF). Prior infection increases the risk of cTHA failure and joint infections. The effectiveness of preoperative hip aspiration for infection diagnosis in THA is known, but its utility before cTHA remains unclear.

Methods:

A retrospective study at Imam Khomeini Hospital Complex, Tehran (2017-2021), included cTHA candidates post-ORIF failure. Exclusions were failed aspiration, recent antibiotics, or insufficient synovial fluid. Patients underwent ESR/CRP testing, joint aspiration, and intraoperative cultures, with the latter as the diagnostic standard.

Results:

The study involved 38 patients (average age 50 ± 16.4 years). Preoperative hip aspiration had a low sensitivity (17.7%) but high specificity (81.0%). CRP showed moderate diagnostic value (AUC 0.643) with an optimal cutoff of 8.8 mg/L (sensitivity 64.3%, specificity 64.7%). ESR was ineffective (AUC 0.577).

Conclusions:

Preoperative hip aspiration for infection diagnosis in cTHA patients had poor sensitivity but high specificity. CRP showed moderate potential, unlike ESR. These findings highlight the need for better diagnostic methods, possibly combining multiple tests. Future research should aim for more accurate diagnostic approaches for infections in cTHA patients.

Level of Evidence: II of Diagnostic Studies

Keywords

Main Subjects

The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 02 December 2025

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History

  • Receive Date: 25 September 2024
  • Revise Date: 16 November 2025
  • Accept Date: 13 April 2025

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