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Updated: May 18, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure
María Eugenia Portillo1, Margarita Salvadó, Lluisa Sorli
1Microbiology Laboratory, Reference Laboratory of Catalunya, Carrer de la Selva, 10, Edifici Inblau A. Parc de Negocis MasBlau I, El Prat de Llobregat, 08820 Barcelona, Spain. eportillo@lrc.es
Objective:
Cultures have limited sensitivity in the diagnosis of prosthetic joint infection (PJI), especially in low-grade infections. We assessed the value of multiplex PCR in differentiating PJI from aseptic failure (AF).
Methods:
Included were patients in whom the joint prosthesis was removed and submitted for sonication. The resulting sonication fluid was cultured and investigated by multiplex PCR, and compared with periprosthetic tissue culture.
Results:
Among 86 explanted prostheses (56 knee, 25 hip, 3 elbow and 2 shoulder prostheses), AF was diagnosed in 62 cases (72%) and PJI in 24 cases (28%). PJI was more common detected by multiplex PCR (n=23, 96%) than by periprosthetic tissue (n=17, 71%, p=0.031) or sonication fluid culture (n=16, 67%, p=0.016). Among 12 patients with PJI who previously received antibiotics, periprosthetic tissue cultures were positive in 8 cases (67%), sonication fluid cultures in 6 cases (50%) and multiplex PCR in 11 cases (92%). In AF cases, periprosthetic tissue grew organisms in 11% and sonication fluid in 10%, whereas multiplex PCR detected no organisms.
Conclusions:
Multiplex PCR of sonication fluid demonstrated high sensitivity (96%) and specificity (100%) for diagnosing PJI, providing good discriminative power towards AF, especially in patients previously receiving antibiotics.
Insights
Multiplex PCR of sonication fluid accurately diagnoses prosthetic joint infection (PJI), outperforming traditional cultures, especially after antibiotic use. This method effectively differentiates PJI from aseptic failure (AF).
Area of Science:
- Orthopedics
- Infectious Diseases
- Molecular Diagnostics
Background:
- Cultures have limited sensitivity for diagnosing prosthetic joint infection (PJI), particularly in low-grade cases.
- Differentiating PJI from aseptic failure (AF) is crucial for appropriate patient management.
Purpose of the Study:
- To evaluate the diagnostic value of multiplex PCR in identifying PJI.
- To compare multiplex PCR performance against traditional culture methods for PJI diagnosis.
Main Methods:
- Sonication fluid and periprosthetic tissue from explanted prostheses were cultured.
- Multiplex PCR was performed on sonication fluid.
- Results were compared between multiplex PCR, sonication fluid culture, and periprosthetic tissue culture.
Main Results:
- Multiplex PCR detected PJI in 96% of cases, significantly higher than periprosthetic tissue (71%) or sonication fluid culture (67%).
- In patients previously treated with antibiotics, multiplex PCR sensitivity remained high (92%).
- Multiplex PCR showed 100% specificity for AF, with no organism detection.
Conclusions:
- Multiplex PCR of sonication fluid offers high sensitivity and specificity for PJI diagnosis.
- This method effectively distinguishes PJI from AF, even in patients with prior antibiotic exposure.
