Higher sensitivity of swab polymerase chain reaction compared with tissue cultures for diagnosing periprosthetic...

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Molecular Diagnostics

Background:

• Periprosthetic joint infection (PJI) diagnosis remains challenging.
• Current gold standard tissue culture has limitations in sensitivity.
• Novel diagnostic methods are needed to improve PJI detection.

Purpose of the Study:

• To evaluate the diagnostic accuracy of swab polymerase chain reaction (PCR) for PJI.
• To compare swab PCR performance against tissue culture, the established gold standard.

Main Methods:

• Prospective enrollment of 41 patients undergoing revision arthroplasty.
• Collection of periprosthetic membrane tissue for culture and implant surface swabs for 16S ribosomal RNA PCR.
• Analysis of diagnostic performance metrics including sensitivity, specificity, and area under the curve.

Main Results:

• Swab PCR demonstrated higher sensitivity (86.4%) compared to tissue culture (68.2%) for PJI diagnosis.
• Both methods showed equal specificity (89.5%).
• Swab PCR achieved a higher area under the curve (0.88) than tissue culture (0.79).

Conclusions:

• Swab PCR is a more sensitive method for diagnosing PJI than tissue culture.
• The ease of implementation and lack of special equipment make swab PCR a promising tool.
• This technique has the potential to enhance the diagnostic capabilities for PJI.