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Updated: Apr 16, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
[Microbiological diagnosis of periprosthetic joint infections]
T Holzmann1, W Schneider-Brachert
1Institut für Klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
Background:
Prosthetic joint infection is a rare but serious complication after arthroplasty, leading to prolonged hospitalization and repeated surgical intervention.
Theme:
In this article, successful strategies for the rapid and accurate microbiological diagnosis of infection are reviewed. In the case of clinical suspicion of a prosthetic joint infection, at least a comprehensive clinical review of the patient's postoperative history, a physical examination, routine blood tests including white cell count, erythrocyte sedimentation rate, and C-reactive protein, and further investigation of the synovial-fluid leukocyte count and microbial culture are needed. Depending of the clinical signs of infection additional blood culture samples should be taken.
Results:
The gold standard to confirm infection is a surgical procedure with at least 5-6 biopsies from suspected areas for both microbial culture and histopathological examination. Culture results may be negative because of previous antimicrobial therapy, a low number of culturable organisms in biofilm formations, inappropriate culture medium, and prolonged transport time.
Conclusion:
In any of these conditions, diagnosis with highly sensitive diagnostic techniques such as polymerase chain reaction should be considered for the identification of the causative agent in order to establish the most appropriate antimicrobial treatment options.
Insights
Diagnosing prosthetic joint infections requires comprehensive evaluation, including clinical review, lab tests, and synovial fluid analysis. Advanced techniques like polymerase chain reaction improve accuracy when standard cultures are negative.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Context:
- Prosthetic joint infection (PJI) is a severe complication following arthroplasty.
- PJI necessitates prolonged hospitalization and multiple surgical procedures.
- Accurate and timely diagnosis is crucial for effective treatment.
Purpose:
- To review effective strategies for the rapid and accurate microbiological diagnosis of prosthetic joint infections.
- To outline essential diagnostic steps in cases of suspected PJI.
- To highlight the limitations of traditional culture methods and the utility of advanced techniques.
Summary:
- Clinical suspicion of PJI warrants a thorough patient history, physical examination, routine blood tests (WBC, ESR, CRP), and synovial fluid analysis (leukocyte count, microbial culture).
- The gold standard for PJI confirmation involves surgical biopsies for microbial culture and histopathology.
- Limitations of culture include prior antibiotic use, low organism load in biofilms, and transport delays, necessitating consideration of sensitive methods like polymerase chain reaction (PCR).
Impact:
- Improved diagnostic accuracy leads to more appropriate and timely antimicrobial therapy.
- Early and precise diagnosis can reduce patient morbidity, hospitalization duration, and healthcare costs.
- Integration of advanced molecular diagnostic techniques can enhance the management of challenging prosthetic joint infections.
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