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Updated: May 27, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Implant sonication for the diagnosis of prosthetic elbow infection
Paschalis Vergidis1, Kerryl E Greenwood-Quaintance, Joaquin Sanchez-Sotelo
1Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Background:
Periprosthetic infection is a potentially devastating complication of elbow arthroplasty, associated with formation of microbial biofilm on the implant surface. The definitive microbiologic diagnosis of periprosthetic infection after elbow arthroplasty may be difficult to establish. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware (a biofilm-sampling strategy).
Materials And Methods:
Patients undergoing revision elbow arthroplasty at our institution between July 2007 and July 2010, from each of whom 2 or more periprosthetic tissue cultures and 1 implant sonicate culture were obtained, were studied. A standardized definition of orthopedic implant-associated infection was applied.
Results:
We identified 27 subjects with aseptic failure and 9 with prosthetic elbow infection. Rheumatoid arthritis was the most common underlying disorder. The Coonrad-Morrey prosthesis was the most common type of implant used. The sensitivities of implant sonicate and periprosthetic tissue culture were 89% and 55%, respectively (P = .18), and the specificities were 100% and 93%, respectively (P = .16). Coagulase-negative staphylococci (n = 7) and Staphylococcus aureus (n = 2) were isolated in cases of infection.
Conclusion:
Culture of the implant by sonication is at least as sensitive as periprosthetic tissue culture to detect prosthetic elbow infection.
Insights
Diagnosing prosthetic elbow infection is challenging. Implant sonication culture demonstrates higher sensitivity than traditional tissue culture for detecting biofilm-associated infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic infection is a severe complication of elbow arthroplasty.
- Microbial biofilm formation on implants complicates diagnosis.
- Accurate microbiologic diagnosis is crucial for effective treatment.
Purpose of the Study:
- To compare the diagnostic accuracy of implant sonication versus conventional tissue culture for periprosthetic elbow infection.
- To evaluate a biofilm-sampling strategy using fluid from explanted hardware.
Main Methods:
- Retrospective study of patients undergoing revision elbow arthroplasty (July 2007-July 2010).
- Collected periprosthetic tissue cultures and implant sonicate cultures.
- Applied a standardized definition of orthopedic implant-associated infection.
Main Results:
- Implant sonication culture showed 89% sensitivity and 100% specificity.
- Periprosthetic tissue culture showed 55% sensitivity and 93% specificity.
- Coagulase-negative staphylococci and Staphylococcus aureus were common pathogens.
Conclusions:
- Implant sonication culture is a highly sensitive method for diagnosing prosthetic elbow infection.
- This biofilm-sampling strategy is at least as sensitive as conventional tissue culture.
