Fluorescence in Situ Hybridization (FISH) for the Diagnosis of Periprosthetic Joint Infection in Formalin-Fixed

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Torsten Lippmann1, Peter Braubach1, Max Ettinger1

  • 1Institute of Pathology (T.L., P.B., M.K., F.L., and D.J.) and Department of Orthopaedic Surgery (M.E.), Hannover Medical School (MHH), Hannover, Germany.

The Journal of Bone and Joint Surgery. American Volume
|January 18, 2019
PubMed
Abstract

Insights

Fluorescence in situ hybridization (FISH) analysis of periprosthetic membranes is a reliable method for diagnosing periprosthetic joint infection (PJI). This technique accurately detects bacteria and identifies specific pathogens, improving diagnostic accuracy for PJI.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • Periprosthetic joint infection (PJI) is a significant challenge following arthroplasty procedures.
  • Accurate diagnosis of PJI is crucial for effective patient management.
  • Current diagnostic guidelines, such as those from the Musculoskeletal Infection Society (MSIS), are essential but can be supplemented.

Purpose of the Study:

  • To evaluate the efficacy of fluorescence in situ hybridization (FISH) in diagnosing PJI.
  • To determine if FISH analysis of periprosthetic membranes improves diagnostic accuracy.
  • To assess FISH's ability to identify specific bacterial pathogens in infected joint implants.

Main Methods:

  • Retrospective analysis of 88 periprosthetic membranes from joint prostheses.
  • Application of FISH with a broad-range bacterial probe.
  • Comparison of FISH results with MSIS clinical classification, microbiological culture, and histopathological analysis.
  • Use of species-specific FISH probes for targeted pathogen identification.

Main Results:

  • FISH demonstrated high accuracy in detecting bacteria in membranes classified as infected by clinical criteria (95% sensitivity).
  • FISH achieved high sensitivity (95.12%) and specificity (87.23%) when compared to histopathological classification.
  • Species-specific FISH probes successfully identified Pseudomonas aeruginosa and Staphylococcus aureus in culture-positive cases.

Conclusions:

  • Fluorescence in situ hybridization (FISH) is a feasible and valuable tool for diagnosing PJI.
  • FISH analysis of periprosthetic membranes enhances diagnostic capabilities, offering both bacterial detection and species differentiation.
  • Combining FISH with clinical and histopathological assessments provides a robust approach for PJI diagnosis.

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