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Updated: Jun 13, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection
Maximilian Schindler1, Panayiotis Christofilopoulos, Blaise Wyssa
1Orthopaedic Surgery Service, Geneva University Hospitals, Geneva, Switzerland.
Abstract:
During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intra-operative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218 days after re-implantation, but only four pre- or intraoperative invasive joint samples had grown a pathogen in cultures. In at least seven recurrent PJIs (58%), patients had a normal C-reactive protein (CRP, < 10 mg/l) level before re-implantation. The sensitivity, specificity, positive predictive and negative predictive values of pre-operative invasive joint aspiration and CRP for the prediction of PJI recurrence was 0.58, 0.88, 0.5, 0.84 and 0.17, 0.81, 0.13, 0.86, respectively. As a conclusion, pre-operative joint aspiration, intraoperative bacterial sampling, surgical exploration and serum inflammatory markers are poor predictors of PJI recurrence. The onset of reinfection usually occurs far later than reimplantation.
Insights
Diagnostic tests like joint aspiration and C-reactive protein (CRP) levels are unreliable for predicting prosthetic joint infection (PJI) recurrence after surgery. Many patients experience reinfection months after reimplantation, even with normal pre-operative markers.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Prosthetic joint infections (PJI) require staged revision surgery.
- Pre-implantation diagnostics aim to detect silent infections before re-implantation.
- The reliability of these diagnostics in asymptomatic patients is unclear.
Purpose of the Study:
- To evaluate the diagnostic performance of joint aspiration, tissue sampling, and inflammatory markers for predicting PJI recurrence.
- To assess the risk of PJI recurrence in asymptomatic patients undergoing two-stage revision.
Main Methods:
- Retrospective analysis of 62 PJI cases in 58 patients undergoing two-stage revision.
- Inclusion of pre-operative joint aspirations, intra-operative swabs, and serum C-reactive protein (CRP) levels.
- Analysis of recurrence rates and timing relative to diagnostic procedures.
Main Results:
- PJI recurrence occurred in 12 cases, with a mean delay of 218 days post-reimplantation.
- Only 4/12 recurrent cases showed positive cultures from pre- or intra-operative samples.
- Normal CRP levels (< 10 mg/L) were observed in 58% of recurrent PJI cases prior to re-implantation.
- Diagnostic values (sensitivity, specificity, PPV, NPV) for joint aspiration and CRP were generally poor predictors of recurrence.
Conclusions:
- Pre-operative joint aspiration, intra-operative sampling, and serum inflammatory markers are poor predictors of PJI recurrence.
- Reinfection often manifests significantly later than the re-implantation stage.
- Current diagnostic methods are insufficient to reliably exclude PJI recurrence in asymptomatic patients.
