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Updated: Aug 13, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
The reliability of diagnosis of infection during revision arthroplasties
P Virolainen1, H Lähteenmäki, A Hiltunen
1Department of Surgery, University of Turku, Finland. petri.virolainen@tyks.fi
Background:
Follow up studies have shown that 0.5 to 4% of the total joint arthroplasties will be complicated by infection. Distinction between aseptic loosening and infection is important for prediction of the final outcome after revision arhtroplasty but also for the choice of operative treatment. However, diagnosis of low grade chronic infection is extremely demanding.
Materials And Methods:
68 hip and knee revision arthroplasties were reviewed retrospectively in order to evaluate the reliability of pre- and perioperative analysis of infection during total joint revision arthroplasties. The sensitivity and specificity for clinical signs, blood white-cell count, C-reactive protein level, radiographic analysis, bone and leukocyte scans, joint aspirations, and gram staining were determined. Tissue sample were harvested and cultured in all cases. Positive cultures were regarded as a true infection.
Results:
We were not able to characterize the infection by clinical signs. Also no single test was able to show the presence of infection in all cases. The best results were obtained from pre- and perioperative joint aspirations. Joint aspiration showed 1.0 specificity and 0.75 sensitivity.
Conclusion:
It is clear from this study that no single test is able to show the presence of infection in every case. Classical clinical signs, laboratory tests, special imaging studies and joint aspirations have all yielded a notable rate of false negative results. Therefore, we recommend that, if arthroplasty patients have pain in prosthetic joint without clear radiological evidence of loosening, bone scans and preoperative joint aspirations should be undertaken. Also, if radiological evidence of loosening is accompanied with one or more of following criteria; C-reactive protein level elevated, radiologic evidence of infection, loosening within the first five years after implantation. In case of infection a delayed two-stage reconstruction should be managed.
Insights
Diagnosing low-grade infection after joint replacement is challenging, as no single test is fully reliable. Combining preoperative joint aspirations with bone scans may improve accuracy in identifying prosthetic joint infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnosis
- Arthroplasty Management
Background:
- Periprosthetic joint infection complicates 0.5-4% of total joint arthroplasties.
- Differentiating infection from aseptic loosening is crucial for revision arthroplasty outcomes and treatment selection.
- Diagnosing low-grade chronic infections presents significant challenges.
Purpose of the Study:
- To evaluate the reliability of pre- and perioperative diagnostic methods for infection in total joint revision arthroplasties.
- To determine the sensitivity and specificity of various clinical and diagnostic tests for identifying prosthetic joint infection.
Main Methods:
- Retrospective review of 68 hip and knee revision arthroplasties.
- Assessment of clinical signs, blood tests (white-cell count, C-reactive protein), radiographic analysis, bone and leukocyte scans, joint aspirations, and Gram staining.
- Tissue samples were harvested and cultured, with positive cultures defining true infection.
Main Results:
- Clinical signs and individual tests were insufficient to reliably characterize infection.
- Pre- and perioperative joint aspirations demonstrated the highest diagnostic utility, with a specificity of 1.0 and sensitivity of 0.75.
- No single test achieved 100% accuracy in detecting infection.
Conclusions:
- No single diagnostic test can definitively identify prosthetic joint infection in all cases.
- Recommended approach for suspected infection includes bone scans and preoperative joint aspirations, especially with pain and no clear loosening.
- Consider delayed two-stage reconstruction for confirmed infections, particularly when accompanied by elevated C-reactive protein or early loosening.
