Sonication in shoulder surgery: is it necessary?

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Medical Diagnostics

Background:

• Peri-implant infections are a significant complication following shoulder surgery.
• Accurate detection of these infections is crucial for effective treatment and patient outcomes.
• Traditional tissue culture methods have limitations in sensitivity for diagnosing certain infections.

Purpose of the Study:

• To compare the diagnostic sensitivity and specificity of sonication versus traditional tissue culture for detecting peri-implant infections in shoulder surgery.
• To evaluate if sonication offers an advantage over conventional methods in identifying pathogens from explanted shoulder implants.

Main Methods:

• A retrospective study involving 99 shoulder surgeries with explanted implants.
• Inclusion criteria: minimum of four tissue cultures, sonication of explanted material, and two-year follow-up.
• Patients classified based on the 2018 International Consensus Meeting on Orthopedic Infections criteria.

Main Results:

• For definitive infections, tissue culture sensitivity was 87.09% and sonication sensitivity was 80.64% (p=0.406).
• Combining definitive, probable, and possible infections, tissue culture sensitivity was 91.4% and sonication sensitivity was 80.4%.
• Specificity was high for both: 99.6% for tissue culture and 98.1% for sonication.

Conclusions:

• Sonication sensitivity (80.64%) is not superior to tissue culture sensitivity (87.09%) in detecting shoulder per-implant infections.
• Both sonication and tissue culture demonstrate high specificity.
• Sonication does not provide a significant benefit for diagnosing shoulder per-implant infections.