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Published on: December 3, 2017
Molecular diagnosis of prosthetic joint infection. A review of evidence
Jirí Gallo1, Milan Raska, Milos Dendis
1Department of Orthopaedics, Teaching Hospital, Olomouc, Czech Republic. jiri.gallo@volny.cz
Abstract:
Prosthetic joint infection (PJI) diagnosis includes several classes of verification. Among them, only a few have a stronger independent value, namely intraarticular purulence and communicating fistulas. Other diagnostic methods require careful test combinations, analysis, and interpretation. Molecular based techniques using the polymerase chain reaction (PCR) seem to be a promising PJI diagnostic modality due to its excellent sensitivity, specificity, positive predictive value, and speed. Most of the recent reviewers are in agreement that molecular diagnosis has enough potential for future application in orthopaedics even if there are only a few heterogeneous studies fully supporting this concept. Conversely, at least one study has been published with significantly worse results (sensitivity and specificity less than 0.75). The lack of supporting evidence in the published studies may be closely related to varying PCR laboratory procedures, inappropriate reference standards, and other methodological shortcomings among research centers. It is not yet justifiable to firmly include molecular methods into the present PJI diagnostic schemes. The orthopaedic community must await the results of well-organized ongoing studies before considering inclusion of molecular diagnostics as a PJI diagnostic method. The aim of this paper was to make a survey of current PJI molecular diagnostic techniques in orthopaedics.
Insights
Molecular diagnostic techniques like polymerase chain reaction (PCR) show promise for prosthetic joint infection (PJI) diagnosis. However, inconsistent results and methodological issues mean PCR is not yet ready for routine orthopedic use.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Molecular Diagnostics
Background:
- Prosthetic joint infection (PJI) diagnosis relies on various methods, with intraarticular purulence and fistulas being key indicators.
- Current diagnostic approaches often require complex interpretation of combined test results.
- Molecular techniques, particularly polymerase chain reaction (PCR), offer potential for rapid and accurate PJI detection.
Purpose of the Study:
- To survey current molecular diagnostic techniques for prosthetic joint infection (PJI) in orthopedics.
- To assess the potential and limitations of PCR-based methods in PJI diagnosis.
Main Methods:
- Review of existing literature on molecular diagnostic techniques for PJI.
- Analysis of studies evaluating the sensitivity, specificity, and predictive value of PCR in PJI diagnosis.
- Identification of methodological variations and shortcomings in current research.
Main Results:
- PCR demonstrates high sensitivity, specificity, and positive predictive value in preliminary studies.
- Significant heterogeneity exists across studies, with some reporting suboptimal performance (sensitivity/specificity < 0.75).
- Inconsistent laboratory procedures and reference standards contribute to variable results.
Conclusions:
- Molecular diagnostics, especially PCR, hold promise for PJI detection but require further validation.
- Current evidence is insufficient to integrate molecular methods into standard PJI diagnostic protocols.
- The orthopedic community should await results from well-designed ongoing studies before adopting these techniques.
