Diagnostic arthroscopy for periprosthetic shoulder arthroplasty infections: a systematic review and meta-analysis

BACKGROUND: Periprosthetic joint infection of the shoulder (PJI) is a devastating complication with a reported incidence of 1%-15.4% and is often difficult to diagnose with current diagnostic tools including serologic tests and arthrocentesis. This systematic review evaluates the reliability and validity of arthroscopic biopsy in the current literature for the diagnosis of shoulder PJI. METHODS: MEDLINE, Scopus, Web of Sciences, Google Scholar, and Cochrane databases were queried electronically from inception to June 2022 for publications reporting diagnostic accuracy of shoulder arthroscopic biopsy for detecting infection after anatomic total shoulder arthroplasty, shoulder hemiarthroplasty, or reverse total shoulder arthroplasty. This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: After exclusion, our meta-analysis consisted of 7 articles with a total of 112 patients. The estimated pooled sensitivity and specificity of arthroscopic biopsy for confirmation of shoulder periprosthetic infection were 0.87 (95% confidence interval [CI]: 0.73-0.95) and 0.79 (95% CI: 0.67-0.88), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.15 (95% CI: 2.57, 6.70) and 0.17 (95% CI: 0.08, 0.36), respectively. The aggregate positive predictive value was 73.58% (95% CI: 63.29%-81.82%), and aggregate negative predictive value was 89.83% (95% CI: 80.59%-94.95%). The diagnostic odds ratio of arthroscopic biopsy was 19.92 (95% CI: 4.96-79.99). CONCLUSION: Arthroscopic biopsy in patients suspected of shoulder PJI has good diagnostic accuracy, with high sensitivity and specificity. Given the various biopsy protocols (such as devices, numbers, locations, etc.), further prospective studies are necessary to define the future role of arthroscopic biopsy in diagnosis and treatment.