Ultrasound- and fluoroscopy-guided hip aspiration before revision total hip arthroplasty: procedural outcomes and diagnostic accuracy in sequential cohorts
DOI:
https://doi.org/10.2340/17453674.2026.46931Keywords:
Arthroplasty, Hip, Implants, Infection, Radiological imagingAbstract
Background and purpose: Hip 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.
Methods: This 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.
Results: The 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).
Conclusion: Dry-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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Parvizi J, Tan T L, Goswami K, Higuera C, Della Valle C, Chen A F, et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 2018; 33: 1309-14.e2. doi: 10.1016/j.arth.2018.02.078. DOI: https://doi.org/10.1016/j.arth.2018.02.078
McNally M, Sousa R, Wouthuyzen-Bakker M, Chen A F, Soriano A, Vogely H C, et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J 2021; 103-B: 18-25. doi: 10.1302/0301-620X.103B1.BJJ-2020-1381.R1. DOI: https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1
Kickinger B, Monsen T, Karis E, Widerström M, Sundin P, Nilsson K G, et al. Evaluation of sonication for the detection of periprosthetic joint infection in hip revision arthroplasty: a retrospective observational single-center study of 288 episodes. Acta Orthop 2025; 96: 429-36. doi: 10.2340/17453674.2025.43679. DOI: https://doi.org/10.2340/17453674.2025.43679
Perry K, Hanssen A. Orthopaedic infection: prevention and diagnosis. J Am Acad Orthop Surg 2017; 25(Suppl 1): 275-84. doi: 10.5435/JAAOS-D-16-00634. DOI: https://doi.org/10.5435/JAAOS-D-16-00634
Kanthawang T, Bodden J, Joseph G B, Vail T, Ward D, Patel R, et al. Diagnostic value of fluoroscopy-guided hip aspiration for periprosthetic joint infection. Skeletal Radiol 2021; 50: 2245-54. doi: 10.1007/S00256-021-03795-8. DOI: https://doi.org/10.1007/s00256-021-03795-8
Soliman S B, Davis J J, Muh S J, Vohra S T, Patel A, van Holsbeeck M T. Ultrasound evaluations and guided procedures of the painful joint arthroplasty. Skeletal Radiol 2022; 51: 2105-20. doi: 10.1007/S00256-022-04080-Y. DOI: https://doi.org/10.1007/s00256-022-04080-y
Piao X, Baylosis B, Murakami A M, Kompel A J. Evaluating key ultrasound findings and their correlations with hip joint aspiration and prosthetic joint infection diagnosis following total hip arthroplasty. Skeletal Radiol 2025; 54: 2139-48. doi: 10.1007/S00256-025-04941-2. DOI: https://doi.org/10.1007/s00256-025-04941-2
Sconfienza L M, Albano D, Messina C, D’Apolito R, De Vecchi E, Zagra L. Ultrasound-guided periprosthetic biopsy in failed total hip arthroplasty: a novel approach to test infection in patients with dry joints. J Arthroplasty 2021; 36: 2962-7. doi: 10.1016/J.ARTH.2021.03.029. DOI: https://doi.org/10.1016/j.arth.2021.03.029
Byrd J W T, Potts E A, Allison R K, Jones K S. Ultrasound-guided hip injections: a comparative study with fluoroscopy-guided injections. Arthroscopy 2014; 30: 42-6. doi: 10.1016/J.ARTHRO.2013.09.083. DOI: https://doi.org/10.1016/j.arthro.2013.09.083
Kottner J, Audigé L, Brorson S, Donner A, Gajewski B J, Hróbjartsson A, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol 2011; 64: 96-106. doi: 10.1016/J.JCLINEPI.2010.03.002. DOI: https://doi.org/10.1016/j.jclinepi.2010.03.002
Battaglia M, Vannini F, Guaraldi F, Rossi G, Biondi F, Sudanese A. Validity of preoperative ultrasound-guided aspiration in the revision of hip prosthesis. Ultrasound Med Biol 2011; 37: 1977-83. doi: 10.1016/j.ultrasmedbio.2011.09.004. DOI: https://doi.org/10.1016/j.ultrasmedbio.2011.09.004
Randelli F, Brioschi M, Randelli P, Ambrogi F, Sdao S, Aliprandi A. Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best? Radiologia Medica 2018; 123: 28-35. doi: 10.1007/s11547-017-0811-1. DOI: https://doi.org/10.1007/s11547-017-0811-1
Treu E A, Cushman D M, Wheelwright J C, Blackburn B E, Teramoto M, Archibeck M J. Is ultrasound-guided hip aspiration more successful than fluoroscopic-guided aspiration in diagnosing prosthetic joint infection? J Bone Jt Infect 2023; 8: 151-63. doi: 10.5194/JBJI-8-151-2023. DOI: https://doi.org/10.5194/jbji-8-151-2023
Duck H, Tanner S, Zillmer D, Osmon D, Perry K. Value of ultrasound-guided aspiration of hip arthroplasties performed in an orthopedic clinic by orthopedic surgeons. J Bone Jt Infect 2021; 6: 393-403. doi: 10.5194/jbji-6-393-2021. DOI: https://doi.org/10.5194/jbji-6-393-2021
Christensen T H, Ong J, Lin D, Aggarwal V K, Schwarzkopf R, Rozell J C. How does a “dry tap” impact the accuracy of preoperative aspiration results in predicting chronic periprosthetic joint infection? J Arthroplasty 2022; 37: 925-9. doi: 10.1016/j.arth.2022.01.066. DOI: https://doi.org/10.1016/j.arth.2022.01.066
Treu E A, Behrens N F, Blackburn B E, Cushman D M, Archibeck M J. A “dry tap” in prosthetic joint infection workup of total hip arthroplasty is not reassuring. J Arthroplasty 2024; 39: S220-4. doi: 10.1016/J.ARTH.2024.02.029. DOI: https://doi.org/10.1016/j.arth.2024.02.029
Copier B, Visser D, van Oldenrijk J, Bos P K, Veltman E S. Preoperative synovial fluid cultures, and biopsy cultures after dry tap aspiration, are valuable in diagnosing a periprosthetic joint infection: a retrospective Study. Microorganisms 2025; 13: 562. doi: 10.3390/MICROORGANISMS13030562. DOI: https://doi.org/10.3390/microorganisms13030562
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Copyright (c) 2026 Thomas J A van Schaik, Kevin May, Gerjon Hannink, Job L C van Susante, Jon H M Goosen, H W Bart Schreuder, Wim H C Rijnen
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