Related Experiment Video
Updated: Feb 17, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic
Christian Morgenstern1, Sabrina Cabric2, Carsten Perka2
1Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Berlin, Germany.
Introduction:
Analysis of joint aspirate is the standard preoperative investigation for diagnosis of periprosthetic joint infection (PJI). We compared the diagnostic performance of culture and multiplex polymerase chain reaction (PCR) of synovial fluid for diagnosis of PJI.
Patients And Methods:
Patients in whom aspiration of the prosthetic hip or knee joint was performed before revision arthroplasty were prospectively included. The performance of synovial fluid culture and multiplex PCR was compared by McNemar's chi-squared test.
Results:
A total of 142 patients were included, 82 with knee and 60 with hip prosthesis. PJI was diagnosed in 77 patients (54%) and aseptic failure in 65 patients (46%). The sensitivity of synovial fluid culture and PCR was 52% and 60%, respectively, showing concordant results in 116 patients (82%). In patients with PJI, PCR missed 6 high-virulent pathogens (S. aureus, streptococci, E. faecalis, E. coli) which grew in synovial fluid culture, whereas synovial fluid culture missed 12 pathogens detected by multiplex PCR, predominantly low-virulent pathogens (Cutibacterium acnes and coagulase-negative staphylococci). In patients with aseptic failure, PCR detected 6 low-virulent organisms (predominantly C. acnes).
Conclusion:
While the overall performance of synovial fluid PCR was comparable to culture, PCR was superior for detection of low-virulent bacteria such as Cutibacterium spp. and coagulase-negative staphylococci. In addition, synovial fluid culture required several days for growth, whereas multiplex PCR provided results within 5hours in an automated manner.
Insights
Multiplex polymerase chain reaction (PCR) of synovial fluid offers faster and more sensitive detection of low-virulent bacteria in periprosthetic joint infection (PJI) cases compared to traditional culture methods.
Area of Science:
- Orthopedics
- Infectious Diseases
- Medical Diagnostics
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on joint aspirate analysis.
- Synovial fluid culture and multiplex polymerase chain reaction (PCR) are key diagnostic tools.
Purpose of the Study:
- To compare the diagnostic performance of synovial fluid culture and multiplex PCR for PJI.
- To evaluate the sensitivity and specificity of each method for detecting various pathogens.
Main Methods:
- Prospective inclusion of 142 patients undergoing revision arthroplasty.
- Comparison of synovial fluid culture and multiplex PCR diagnostic performance using McNemar's chi-squared test.
Main Results:
- Multiplex PCR showed higher sensitivity (60%) than culture (52%) for PJI diagnosis.
- PCR excelled in detecting low-virulent bacteria (Cutibacterium spp., coagulase-negative staphylococci), while culture identified more high-virulent pathogens.
- PCR provided results within 5 hours, significantly faster than culture.
Conclusions:
- Multiplex PCR is a valuable tool for PJI diagnosis, particularly for low-virulent infections.
- The rapid turnaround time of PCR improves diagnostic efficiency.
- Combining PCR with culture may offer comprehensive pathogen detection for PJI.
Related Concept Videos
01:20Sputum Studies II: Culture and Sensitivity
Sputum culture and sensitivity is a medical procedure used to diagnose bacterial infections in the respiratory tract and select the most appropriate antibiotics for treatment. This process involves analyzing sputum samples of thick and opaque secretions produced in the lungs and airways. These samples are collected from patients and then sent to the laboratory for analysis.
The test can identify various pathogens responsible for respiratory infections, including Streptococcus,...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urine Studies II: Urine Culture and Sensitivity Test