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Updated: Feb 21, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Performance of automated multiplex PCR using sonication fluid for diagnosis of periprosthetic joint infection: a
Nora Renz1, Susanne Feihl2, Sabrina Cabric2,3
1Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Charitéplatz 1, 10117, Berlin, Germany. nora.renz@charite.de.
Purpose:
Sonication of explanted prostheses improved the microbiological diagnosis of periprosthetic joint infections (PJI). We evaluated the performance of automated multiplex polymerase chain reaction (PCR) using sonication fluid for the microbiological diagnosis of PJI.
Methods:
In a prospective cohort using uniform definition criteria for PJI, explanted joint prostheses were investigated by sonication and the resulting sonication fluid was analyzed by culture and multiplex PCR. McNemar's Chi-squared test was used to compare the performance of diagnostic tests.
Results:
Among 111 patients, PJI was diagnosed in 78 (70%) and aseptic failure in 33 (30%). For the diagnosis of PJI, the sensitivity and specificity of periprosthetic tissue culture was 51 and 100%, of sonication fluid culture 58 and 100%, and of sonication fluid PCR 51 and 94%, respectively. Among 70 microorganisms, periprosthetic tissue culture grew 52 (74%), sonication fluid culture grew 50 (71%) and sonication fluid PCR detected 37 pathogens (53%). If only organisms are considered, for which primers are included in the test panel, PCR detected 37 of 58 pathogens (64%). The sonication fluid PCR missed 19 pathogens (predominantly oral streptococci and anaerobes), whereas 7 additional microorganisms were detected only by PCR (including Cutibacterium spp. and coagulase-negative staphylococci).
Conclusions:
The performance of multiplex PCR using sonication fluid is comparable to culture of periprosthetic tissue or sonication fluid. The advantages of PCR are short processing time (< 5 h) and fully automated procedure. However, culture technique is still needed due to the low sensitivity and the need of comprehensive susceptibility testing. Modification of primers or inclusion of additional ones may improve the performance of PCR, especially of low-virulent organisms.
Insights
Sonication fluid multiplex polymerase chain reaction (PCR) shows promise for diagnosing periprosthetic joint infections (PJI), offering rapid results. However, culture remains essential for comprehensive testing and detecting certain pathogens.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
- Molecular Diagnostics
Background:
- Periprosthetic joint infection (PJI) diagnosis relies heavily on microbiological analysis.
- Sonication of explanted prostheses enhances pathogen recovery for microbiological diagnosis.
- Multiplex polymerase chain reaction (PCR) offers a rapid diagnostic approach.
Purpose of the Study:
- To evaluate the performance of automated multiplex PCR using sonication fluid for PJI microbiological diagnosis.
- To compare multiplex PCR with traditional culture methods in diagnosing PJI.
Main Methods:
- Prospective cohort study with uniform PJI definition criteria.
- Explanted prostheses sonicated; sonication fluid analyzed by culture and multiplex PCR.
- McNemar's Chi-squared test used for performance comparison.
Main Results:
- PJI diagnosed in 78/111 patients (70%).
- Sonication fluid PCR sensitivity 51%, specificity 94%; missed 19 pathogens (oral streptococci, anaerobes).
- PCR detected 7 additional microorganisms (Cutibacterium spp., coagulase-negative staphylococci).
Conclusions:
- Multiplex PCR performance is comparable to culture but offers faster results.
- Culture remains necessary due to PCR's lower sensitivity and need for susceptibility testing.
- Primer modification could improve PCR detection of low-virulent organisms.
