A “Dry Tap” in Prosthetic Joint Infection Workup of Total Hip Arthroplasty Is Not Reassuring

• Published in: The Journal of arthroplasty 2024-09, Vol.39 (9), p.S220-S224
• Main Authors: Treu, Emily A., Behrens, Nathan F., Blackburn, Brenna E., Cushman, Daniel M., Archibeck, Michael J.
• Format: Article
• Language: English
• Subjects: aspiration; dry tap; prosthetic joint infection; synovial fluid; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2024.02.029

Synovial fluid analysis is important in diagnosing prosthetic joint infection (PJI). The rate of culture-positive PJI in patients who have a dry tap of a total hip arthroplasty (THA) is not well described. We reviewed all image-guided THA aspirations, performed from 2014 to 2021 at a single academic institution. Aspirations were categorized as successful (≥ 0.5 mL) or unsuccessful (< 0.5 mL, “dry tap”). We analyzed culture data on all repeat aspirations and revision surgeries performed within 90 days of the initial dry tap. We reviewed 275 consecutive attempted THA aspirations of which 100 (36.4%) resulted in a dry tap. The dry tap cohort had a significantly higher percentage of fluoroscopic-guided aspirations (64%) and fewer ultrasound-guided aspirations (36%) compared to the successful aspiration cohort (48.9% fluoroscopic, 53.1% ultrasound, P = .0061). Of the 100 patients who have dry taps, 48 underwent revision surgery within 90 days of the initial dry tap, and 15 resulted in 2 or more positive cultures. The rate of PJI defined by MusculoSkeletal Infection Society major criteria in the dry tap cohort was 16.0%. Attempted aspiration of a THA resulted in a dry tap 36.4% of the time. Of those patients who had a dry tap, 16.0% were subsequently found to have PJI based on MusculoSkeletal Infection Society major criteria. Therefore, a “dry tap” does not exclude the diagnosis of infection and should not be considered reassuring for the absence of PJI.