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Updated: Aug 13, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Improved identification of polymicrobial infection in total knee arthroplasty through sonicate fluid cultures
V Janz1, G I Wassilew2, M Kribus3
1Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. Viktor.Janz@Charite.de.
Introduction:
Periprosthetic joint infection (PJI) is the leading cause for early failure of total knee arthroplasty (TKA). An insufficient diagnosis of the involved bacterial species can be a possible cause for this high failure rate. Sonicate fluid cultures (SFC) have been shown to increase the detection rate of PJI in comparison to the use of conventional microbiological methods. The hypothesis of this study is that sonication will improve not only the detection rate of PJI, but also the detection rate of polymicrobial infection in patients with TKA revision surgery.
Materials And Methods:
109 patients, undergoing TKA revision surgery, were enrolled in this prospective cohort study and received a synovial aspiration, intraoperative tissue cultures, histological sampling of the periprosthetic membrane (PM), and sonication of the explanted endoprosthesis. A PJI was defined according to the following criteria: presence of intraarticular pus or a sinus tract, positive isolation of the same bacterial species in ≥2 microbiological samples or a PM indicative of infection.
Results:
31 patients had a defined PJI according to the above-mentioned criteria. SFC achieved the highest sensitivity (74 %) of all microbiological methods. The PM achieved a sensitivity of 87 %. When the results of the SFC and the PM were combined, it was possible to further increase the sensitivity to 94 %. The utilization of SFC doubled the number of polymicrobial bacterial isolations in our patient collective. There were 12 cases of polymicrobial bacterial isolations, six were detectable through conventional microbiological methods, four were detectable through SFC and two were identifiable as polymicrobial through the isolation of an additional bacterial species in the SFC.
Conclusions:
In our study, SFC were the most sensitive microbiological method and were surpassed only by the histology. The use of SFC doubled the detection rate of polymicrobial isolations, which would be missed with conventional microbiological methods alone.
Insights
Sonicate fluid cultures (SFC) significantly improve the detection of periprosthetic joint infection (PJI) and polymicrobial infections in total knee arthroplasty (TKA) revision surgery. Combining SFC with periprosthetic membrane histology offers the highest diagnostic sensitivity for PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a primary cause of early total knee arthroplasty (TKA) failure.
- Accurate diagnosis of bacterial species is crucial for effective PJI treatment.
- Conventional methods may underestimate PJI and polymicrobial infections.
Purpose of the Study:
- To evaluate the efficacy of sonicate fluid cultures (SFC) in detecting PJI.
- To assess the impact of SFC on identifying polymicrobial infections in TKA revision.
- To compare SFC with conventional microbiological methods and histological analysis.
Main Methods:
- Prospective cohort study of 109 patients undergoing TKA revision.
- Inclusion of synovial aspiration, intraoperative cultures, periprosthetic membrane (PM) histology, and explanted prosthesis sonication.
- PJI definition based on pus, sinus tract, microbiological, or histological findings.
Main Results:
- 31 patients were diagnosed with PJI.
- SFC demonstrated the highest sensitivity (74%) among microbiological methods.
- Combining SFC with PM histology yielded a 94% sensitivity for PJI detection.
- SFC doubled the detection rate of polymicrobial bacterial isolations.
Conclusions:
- SFC is a highly sensitive microbiological method for PJI diagnosis, second only to histology.
- SFC significantly enhances the detection of polymicrobial infections, often missed by conventional methods.
- The combination of SFC and PM histology provides superior diagnostic accuracy for PJI in TKA revision.
