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Updated: Aug 14, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
[Septic loosing of hip and knee prosthesis]
Grzegorz Szczesny1, Ireneusz Babiak, Michał Kowalewski
1Katedra i Klinika Ortopedii i Traumatologii Narzadu Ruchu, Akademia Medyczna w Warszawie.
Abstract:
Loosening of an artificial joint is a common complication in orthopedic surgery. It is estimated that bacteriological implant contamination is responsible for its loosening in 2-5 percent of cases, and in most cases aseptic loosening takes place. Despite low percentage of positive microbiological studies, histopathological examinations and modern laboratory techniques, including PCR (Polymerase Chain Reaction) allow to diagnose the bacterial contamination of the loose implant to ca 70 percent. Those observations point out to the high coincidence of bacterial contamination with implant loosening strongly suggesting its influence on activation of the inflammatory process destabilizing an implant. But the question, why in those cases bacterial contamination does not lead to clinically obvious suppuration, remains unknown. The possibility to activate the immune system by the subcellular elements of the bacterial cells leading to persistent inflammation with granulation tissue formation is likely. Presented paper discusses the process of orthopedic prosthesis loosening, the role of bacterial contamination in it. and the newest techniques for their examination.
Insights
Bacterial contamination may cause artificial joint loosening in orthopedic surgery, even without obvious infection. Advanced techniques detect bacterial presence in up to 70% of loose implants, suggesting a role in inflammation.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Microbiology
Context:
- Artificial joint loosening is a frequent complication in orthopedic procedures.
- Bacteriological contamination is implicated in 2-5% of cases, though aseptic loosening is more common.
- Diagnosing bacterial contamination in loose implants is challenging yet crucial.
Purpose:
- To explore the role of bacterial contamination in orthopedic prosthesis loosening.
- To discuss the mechanisms by which bacteria may destabilize implants without causing suppuration.
- To review modern diagnostic techniques for identifying bacterial presence in loosened implants.
Summary:
- While aseptic loosening is prevalent, bacterial contamination is frequently found in loose orthopedic implants (up to 70% with advanced diagnostics like PCR).
- The study suggests that sub-cellular bacterial components may trigger immune responses, leading to chronic inflammation and implant loosening.
- The exact mechanism for implant loosening without overt clinical signs of infection remains an area of investigation.
Impact:
- Highlights the significance of subclinical bacterial contamination in orthopedic implant failure.
- Emphasizes the need for advanced diagnostic methods to accurately assess implant-associated infections.
- Informs future strategies for preventing and managing orthopedic implant loosening.