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Rapid detection of periprosthetic joint infection using a combination of 16s rDNA polymerase chain reaction and

V Janz1, J Schoon2, C Morgenstern3

  • 1Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany viktor.janz@charite.de.

Bone & Joint Research
|January 7, 2018
PubMed
Abstract

Insights

A new 16s rDNA test rapidly detects bacteria in synovial fluid within 25 minutes, aiding in the diagnosis of periprosthetic joint infection (PJI). This molecular test offers high accuracy, comparable to traditional methods, for timely intraoperative results.

Area of Science:

  • Orthopedics
  • Microbiology
  • Molecular Diagnostics

Background:

  • Periprosthetic joint infection (PJI) is a severe complication of joint replacement surgery.
  • Accurate and rapid diagnosis of PJI is crucial for effective treatment and patient outcomes.
  • Current diagnostic methods, such as microbiological culture, can be time-consuming.

Purpose of the Study:

  • To develop and validate a rapid (within 25 minutes) intraoperative test for bacterial detection in synovial fluid.
  • To diagnose periprosthetic joint infection (PJI) effectively.
  • To assess the performance of a novel 16s rDNA test compared to conventional methods.

Main Methods:

  • A novel 16s rDNA test was developed, combining polymerase chain reaction (PCR) with lateral flow immunoassay in an automated system.
  • Synovial fluid samples from 77 patients undergoing hip or knee surgery were prospectively collected.
  • The test was validated in two cohorts (n=17 and n=60), with PJI defined by established microbiological and clinical criteria.

Main Results:

  • The 16s rDNA test provided results for 97% of samples within 25 minutes.
  • The test demonstrated high diagnostic accuracy for PJI: sensitivity of 87.5% and specificity of 100% in the proof-of-principle cohort, and 82% sensitivity and 89% specificity in the validation cohort.
  • Performance was robust, independent of blood contamination, culture time, or bacterial species.

Conclusions:

  • The 16s rDNA test enables reliable intraoperative detection of bacterial species for PJI diagnosis within 25 minutes.
  • Its sensitivity and specificity are comparable to conventional synovial fluid culture.
  • This rapid test offers a significant advancement for intraoperative decision-making in PJI management.
Keywords:
16s rDNAImmunoassayLateral flowPeriprosthetic joint infectionPolymerase chain reactionRapid detection

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