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Updated: Jun 16, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants
Yvonne Achermann1, Markus Vogt, Michael Leunig
1Infectious Diseases Service, Department of Internal Medicine, Cantonal Hospital Zug, Baar, Switzerland.
Abstract:
The microbiological diagnosis of periprosthetic joint infection (PJI) is crucial for successful antimicrobial treatment. Cultures have limited sensitivity, especially in patients receiving antibiotics. We evaluated the value of multiplex PCR for detection of microbial DNA in sonication fluid from removed orthopedic prostheses. Cases of PJI in which the prosthesis (or part of it) was removed were prospectively included. The removed implant was sonicated, and the resulting sonication fluid was cultured and subjected to multiplex PCR. Of 37 PJI cases (17 hip prostheses, 14 knee prostheses, 4 shoulder prostheses, 1 elbow prosthesis, and 1 ankle prosthesis), pathogens were identified in periprosthetic tissue in 24 (65%) cases, in sonication fluid in 23 (62%) cases, and by multiplex PCR in 29 (78%) cases. The pathogen was detected in 5 cases in sonication fluid only (Propionibacterium acnes in all cases; none of these patients had previously received antibiotics) and in 11 cases by multiplex PCR only (all of these patients had previously received antibiotics). After exclusion of 8 cases caused by P. acnes or Corynebacterium species, which cannot be detected due to the absence of specific primers in the PCR kit, sonication cultures were positive in 17 cases and multiplex PCR sonication cultures were positive in 29 cases (59% versus 100%, respectively; P < 0.01). Among 19 cases (51%) receiving antibiotics, multiplex PCR was positive in all 19 (100%), whereas sonication cultures grew the organism in 8 (42%) (P < 0.01). Multiplex PCR of sonication fluid is a promising test for diagnosis of PJI, particularly in patients who previously received antibiotics. With modified primer sets, multiplex PCR has the potential for further improvement of the diagnosis of PJI.
Insights
Multiplex PCR of sonication fluid improves periprosthetic joint infection (PJI) diagnosis, especially in patients on antibiotics. This molecular test offers higher pathogen detection rates than traditional cultures for diagnosing PJI.
Area of Science:
- Microbiology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Accurate microbiological diagnosis of periprosthetic joint infection (PJI) is essential for effective antimicrobial therapy.
- Conventional culture methods for PJI diagnosis have limitations, particularly reduced sensitivity in patients who have received prior antibiotic treatment.
Purpose of the Study:
- To evaluate the diagnostic utility of multiplex PCR for microbial DNA detection in sonication fluid from removed orthopedic prostheses for PJI cases.
Main Methods:
- Prospective inclusion of PJI cases with prosthesis removal.
- Sonication of removed implants to obtain sonication fluid.
- Analysis of sonication fluid using both conventional microbiological cultures and multiplex PCR.
Main Results:
- Multiplex PCR detected pathogens in 78% of PJI cases, compared to 65% in periprosthetic tissue and 62% in sonication fluid cultures.
- Pathogen detection was significantly higher with multiplex PCR (100%) versus sonication cultures (42%) in patients who had received antibiotics.
- Multiplex PCR identified pathogens missed by cultures in 11 cases, particularly in patients with prior antibiotic exposure.
Conclusions:
- Multiplex PCR of sonication fluid is a valuable and sensitive tool for diagnosing PJI, especially in patients pre-treated with antibiotics.
- The sensitivity of multiplex PCR for PJI diagnosis surpasses conventional culture methods.
- Further improvements in multiplex PCR, such as modified primer sets, hold potential for enhancing PJI diagnosis.
