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Updated: May 9, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Prosthetic infection: improvement of diagnostic procedures using 16S ribosomal deoxyribonucleic acid polymerase chain
Arnold J Suda1, Mechthild Kommerell, Heinrich K Geiss
1Department of Orthopaedics and Trauma, Heidelberg University Hospital, Heidelberg, Germany, arnold@drsuda.com.
Purpose:
Prosthetic infection is the worst complication in joint arthroplasty. The diagnostic procedure is time consuming and in many cases unrewarding. The aim of this investigation was to raise the sensitivity of the diagnostic procedure.
Methods:
Altogether, 229 implants were removed from 229 patients. Complete data from 157 patients could be analysed. On explantation of the respective arthroplasty, tissue was removed, puncture fluid aspirated and biofilm scratched from the implant surface with a surgical knife. Specimens were investigated with conventional culture methods and with 16S ribosomal DNA (rDNA) polymerase chain reaction (PCR) and sequencing.
Results:
In 123 cases, no pathogen could be identified by routine culture methods. In three of these culture-negative cases, bacteria could be identified with 16S rDNA sequencing of the removed biofilm. In 34 cases, bacteria could be identified with culture methods. In two of these cases, sequencing detected additional pathogens.
Conclusions:
The process of 16S ribosomal deoxyribonucleic acid polymerase chain reaction (rDNA PCR) and sequencing of biofilm removed from the explanted prosthesis is an important addition to conventional culture methods in prosthetic joint infection. Polymerase chain reaction detects additional pathogens and improves diagnostic sensitivity. The examination of tissue, puncture fluid and biofilm should be performed in cases of prosthesis loosening and explantation.
Insights
16S ribosomal DNA (rDNA) sequencing of prosthetic joint biofilm improves pathogen detection over traditional cultures. This enhanced diagnostic sensitivity aids in identifying infections, improving outcomes for patients undergoing arthroplasty revision surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Molecular Diagnostics
Background:
- Prosthetic joint infection is a severe complication of arthroplasty.
- Current diagnostic methods for prosthetic joint infection are often time-consuming and have limited sensitivity.
Purpose of the Study:
- To enhance the sensitivity of diagnostic procedures for prosthetic joint infections.
- To evaluate the utility of 16S ribosomal DNA (rDNA) polymerase chain reaction (PCR) and sequencing for identifying pathogens in prosthetic joint infections.
Main Methods:
- Tissue, puncture fluid, and biofilm samples were collected from 157 explanted arthroplasties.
- Specimens were analyzed using conventional culture methods and 16S rDNA PCR and sequencing.
Main Results:
- Conventional cultures failed to identify pathogens in 123 cases.
- 16S rDNA sequencing identified bacteria in three culture-negative cases.
- Sequencing detected additional pathogens in two cases where culture methods were positive.
Conclusions:
- 16S rDNA PCR and sequencing of biofilm is a valuable addition to conventional methods for diagnosing prosthetic joint infections.
- This molecular technique improves diagnostic sensitivity by detecting pathogens missed by culture.
- Examination of tissue, fluid, and biofilm is recommended for prosthesis loosening and explantation.
