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Updated: Mar 5, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Identification of Asymptomatic Prosthetic Joint Infection: Microbiologic and Operative Treatment Outcomes
Przemysław L Bereza1, Alicja Ekiel2, Aleksandra Auguściak-Duma3
11 Department of Orthopaedic and Traumatology, School of Medicine in Katowice, Medical University of Silesia , Katowice, Poland .
Background:
This prospective study investigated the role of mechanical and biological factors in aseptic implant loosening or presumed silent prosthetic joint infection (PJI).
Methods:
Thirty-seven patients were investigated. Microbiologic and molecular methods were used to detect bacteria on the surface of the failed implants removed during revision arthroplasty. Histopathologic analysis was performed. The influence of body mass index (BMI) and various co-morbidities on implant failure also was determined.
Results:
The results of sonicated fluid cultures were positive for bacteria in 29.7% and the results of intra-operative tissue and joint liquid cultures in 18.9% and 16.2%, respectively. Molecular detection with 16S rRNA sequencing revealed a large variety of bacteria. The most frequent organism was coagulase-negative Staphylococcus (CNS). The outcomes of histopathologic tests of peri-prosthetic tissue showed evidence of the infection type in all culture-positive joints and in 41.4% of the cases with negative culture results. Overweight status or obesity was present in 82.8% of the culture-negative patients.
Conclusions:
The results of this study proved the presence of micro-organisms on the surface of implants in both aseptic and presumed PJI cases. Inclusion of the sonication procedure in the diagnostic algorithm increased the ability to identify the pathogen. The results of our study suggest the co-existing roles of BMI and the time to implant loosening as well as biological agents in causing prosthesis loosening.
Insights
Microbial presence on implants contributes to loosening, even in presumed aseptic cases. Advanced techniques like sonication improve pathogen detection, highlighting the interplay of biological factors and patient BMI in prosthesis failure.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomaterials Science
Background:
- Investigated mechanical and biological factors in aseptic implant loosening.
- Examined presumed silent prosthetic joint infection (PJI).
Purpose of the Study:
- To determine the role of microorganisms in aseptic implant loosening.
- To assess the impact of BMI and comorbidities on implant failure.
Main Methods:
- Analyzed 37 revision arthroplasty cases.
- Utilized microbiologic, molecular (16S rRNA sequencing), and histopathologic analyses.
- Assessed body mass index (BMI) and comorbidities.
Main Results:
- Bacteria detected on implants in 29.7% of sonicated fluid cultures.
- Coagulase-negative Staphylococcus (CNS) was the most common organism.
- Histopathology confirmed infection in culture-negative cases (41.4%); obesity was prevalent in these patients (82.8%).
Conclusions:
- Microorganisms are present on implants in both aseptic and PJI cases.
- Sonication enhances pathogen identification in diagnosing PJI.
- Prosthesis loosening involves combined effects of BMI, time, and biological agents.
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