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Updated: Aug 16, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases
Konstantinos Panousis1, Peter Grigoris, Ian Butcher
1Department of Orthopaedic Surgery, University of Glasgow, Glasgow, UK. panousis@hotmail.com
Background:
The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific. Recent advances in molecular biology have enabled the detection of infection in culture negative cases.
Patients And Methods:
We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment. 12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%.
Interpretation:
The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.
Insights
Polymerase chain reaction (PCR) shows high sensitivity but low specificity for diagnosing prosthetic joint infections. This molecular test is not recommended for routine use due to frequent false positives in revision arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Molecular Diagnostics
Background:
- Diagnosing prosthetic joint infections is difficult, lacking a definitive test.
- Molecular methods offer potential for detecting infection in culture-negative cases.
Purpose of the Study:
- To evaluate the effectiveness of polymerase chain reaction (PCR) for detecting infection in failed joint replacements.
- Assessing PCR's diagnostic accuracy in revision total hip or knee arthroplasty.
Main Methods:
- Prospective study of 91 patients undergoing revision arthroplasty.
- Intraoperative synovial fluid analyzed using broad-range PCR for bacterial DNA.
- Clinical diagnosis based on multiple criteria including cultures and histology.
Main Results:
- 13% of joints were infected (12/92).
- PCR detected bacterial DNA in 32 cases, yielding a sensitivity of 92% and specificity of 74%.
- The negative predictive value was high (98%), but the positive predictive value was low (34%).
Conclusions:
- PCR is not recommended for routine diagnosis of prosthetic joint infections.
- High false positive rates may stem from contamination, low-virulence bacteria, or host immune responses.