Related Experiment Video
Updated: Oct 2, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis
Konstantinos Tsikopoulos1, Savas Ilias Christofilos2, Dimitrios Kitridis3
11st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. ktsikopo@auth.gr.
Purpose:
Even though effective techniques in diagnosis of periprosthetic joint infections (PJIs) have been developed, the optimal modality has yet to be determined. The present meta-analysis aimed to compare the diagnostic accuracy of dithiothreitol (DTT) and sonication against the Musculoskeletal Infection Society criteria in patients undergoing revision joint surgery.
Methods:
We searched the PubMed, Scopus, and Central Cochrane register of controlled trials as well as gray literature until the 9th of November, 2021. We included articles considering the comparative diagnostic accuracy of sonication and DTT in adult patients having revision hip and knee arthroplasty for septic or aseptic reasons. We calculated pooled sensitivity, specificity, and diagnostic accuracy of the above diagnostic techniques against the Musculoskeletal Infection Society (MSIS) criteria and created receiver operating characteristics (ROC) curves to enable comparisons between each other. The quality of included papers was evaluated utilizing QUADAS-2 and QUADAS-C tools.
Results:
Data from five comparative studies totaling 726 implants were pooled together. The diagnostic accuracy of DTT and sonication were 86.7% (95% CI 82.7 to 90.1) and 83.9% (95% CI 79.7 to 87.5), respectively. Pooled sensitivity and specificity showed no statistically significant differences between DTT and sonication (0.7 [95% CI 0.62 to 0.77] vs 0.72 [95% CI 0.65 to 0.78], p = 0.14; and 0.99 [95% CI 0.97 to 1] vs 0.97 [95% CI 0.93 to 0.99], p = 5.5, respectively).
Conclusions:
This meta-analysis did not identify any clinically meaningful difference between the diagnostic potential of sonication and the chemical-based biofilm dislodgment methods. This finding remained robust after adjusting for the administration of antibiotics prophylaxis, implementation of the polymerase chain reaction of sonicated fluid, and study quality.
Insights
This meta-analysis found no significant difference in diagnostic accuracy between dithiothreitol (DTT) and sonication for periprosthetic joint infections (PJIs). Both methods are effective for diagnosing PJIs in revision joint surgery patients.
Area of Science:
- Orthopedics
- Infectious Diseases
- Medical Diagnostics
Background:
- Periprosthetic joint infections (PJIs) pose a significant challenge in revision joint surgery.
- Accurate diagnosis is crucial for effective treatment, yet optimal diagnostic modalities remain debated.
Purpose of the Study:
- To compare the diagnostic accuracy of dithiothreitol (DTT) and sonication against the Musculoskeletal Infection Society (MSIS) criteria.
- To evaluate diagnostic techniques for PJIs in patients undergoing revision hip and knee arthroplasty.
Main Methods:
- A meta-analysis of five comparative studies involving 726 implants.
- Searched PubMed, Scopus, Cochrane, and gray literature up to November 2021.
- Calculated pooled sensitivity, specificity, and diagnostic accuracy; generated ROC curves; assessed study quality using QUADAS-2 and QUADAS-C.
Main Results:
- DTT showed a diagnostic accuracy of 86.7% (95% CI 82.7 to 90.1), while sonication had 83.9% (95% CI 79.7 to 87.5).
- No statistically significant differences were found in pooled sensitivity (0.70 vs 0.72) or specificity (0.99 vs 0.97) between DTT and sonication.
- These findings were robust even after adjusting for antibiotic prophylaxis, PCR of sonicated fluid, and study quality.
Conclusions:
- No clinically meaningful difference exists between DTT and sonication for diagnosing PJIs.
- Both chemical-based biofilm dislodgment (DTT) and sonication are comparable in their diagnostic potential.
- The choice between DTT and sonication may not significantly impact diagnostic outcomes in revision joint surgery.
