Related Experiment Video
Updated: May 1, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections
Background:
Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures.
Questions/Purposes:
Our aims in this study were to determine (1) if sonication results were predictive of failure, including reinfection, at 2-year followup; and (2) whether sonication of antibiotic spacers at the time of reimplantation improves sensitivity of intraoperative cultures.
Methods:
We prospectively followed 36 consecutive patients undergoing two-stage reimplantation for periprosthetic hip or knee infection. Minimum followup was 19 months (mean, 29.9 months; range, 19–38 months). Results of intraoperative cultures and sonicated antibiotic spacers were analyzed.
Results:
Positive sonication results were predictive of failure as defined by reinfection at 2-year followup. Among the 18 patients who had positive sonication results, reinfection developed in nine patients (50%) compared with two of 18 patients (11%) with negative sonication results (odds ratio, 8.0; 95% CI, 1.2–69.0). Sonication of antibiotic spacers improved the sensitivity of intraoperative cultures from 45% to 82%. [corrected].
Conclusions:
Sonication of antibiotic spacers appears to be useful in predicting failure attributable to recurrent infection after two-stage reimplantation. For patients with positive sonication cultures during reimplantation, more aggressive antimicrobial treatment may be indicated after reimplantation.
Level Of Evidence:
Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
Insights
Sonication of antibiotic spacers accurately predicts reinfection after two-stage reimplantation for periprosthetic joint infection. This method also significantly improves the sensitivity of intraoperative cultures, aiding in earlier detection.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Periprosthetic joint infection is a major cause of failure in two-stage reimplantation surgery.
- Detecting biofilm-forming bacteria, a cause of infection relapse, remains challenging.
- Sonication is a technique that disrupts bacterial biofilms and enhances culture sensitivity.
Purpose of the Study:
- To evaluate if sonication results predict 2-year failure rates, including reinfection, after two-stage reimplantation.
- To determine if sonication of antibiotic spacers improves intraoperative culture sensitivity.
Main Methods:
- Prospective study of 36 patients undergoing two-stage reimplantation for periprosthetic joint infection.
- Analysis of intraoperative cultures and sonicated antibiotic spacers.
- Follow-up for a minimum of 19 months (mean 29.9 months).
Main Results:
- Positive sonication results were predictive of reinfection (50% vs. 11% reinfection rate).
- Sonication of antibiotic spacers increased culture sensitivity from 45% to 82%.
- Positive sonication results showed an odds ratio of 8.0 for reinfection.
Conclusions:
- Sonication of antibiotic spacers is a valuable tool for predicting recurrent infection after two-stage reimplantation.
- Positive sonication cultures may warrant more aggressive antimicrobial therapy post-reimplantation.
More Related Videos
06:18A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials
Published on: March 3, 2023
18:40Combined In vivo Optical and µCT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice
Published on: October 16, 2014