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Published on: December 3, 2017
Improved detection methods for infected hip joint prostheses
Dan Høgdall1, Jørgen Jesper Hvolris, Lise Christensen
1Department of Orthopedic Surgery, Bispebjerg Hospital, University of Copenhagen, Denmark.
Abstract:
Awareness of the role of bacterial biofilm in the pathogenesis of low-grade or chronic infections diagnosed in hip arthroplasty has been on the rise in recent years. The importance of bacterial biofilm for the development of prosthesis failure is probably underestimated, and terms like aseptic loosening, sterile pus and aseptic necrosis are up for revision. The diagnosis of biofilm has been, and still is, difficult, but new molecular biological techniques, alone or in combination with older established ones, have further helped us to uncover lesions, where biofilm is part of the pathology. This article based on a literature search and own observations is primarily focused on newer methods that help us identify the pathology behind infection-based prosthesis failure. We suggest that the fluorescence in situ hybridization technique on carefully selected biopsy material is used in the future to identify live as well as dead bacteria within their environment. The method is quick and sensitive and provides a reliable result with optimal detection rate.
Insights
Bacterial biofilm plays a key role in chronic hip arthroplasty infections and prosthesis failure. Fluorescence in situ hybridization (FISH) offers a sensitive and reliable method for diagnosing these challenging infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Bacterial biofilm is increasingly recognized in chronic hip arthroplasty infections.
- Its role in prosthesis failure, including aseptic loosening, is likely underestimated.
- Diagnosing biofilm infections has historically been challenging.
Purpose of the Study:
- To review newer diagnostic methods for biofilm-related prosthesis failure.
- To highlight techniques for identifying bacterial pathology in infected hip arthroplasty.
Main Methods:
- Literature search and analysis of own observations.
- Focus on molecular biological techniques combined with established methods.
- Emphasis on fluorescence in situ hybridization (FISH).
Main Results:
- Newer molecular techniques aid in uncovering biofilm-associated lesions.
- FISH is presented as a promising diagnostic tool.
- FISH can identify both live and dead bacteria within their environment.
Conclusions:
- Bacterial biofilm is a critical factor in hip arthroplasty infection and failure.
- Fluorescence in situ hybridization (FISH) is a rapid, sensitive, and reliable method for diagnosing biofilm.
- FISH can improve the detection rate of infections in prosthesis failure cases.
