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Updated: Aug 7, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Assessment of Microbiological and Clinical Findings of Two-Stage Revision Arthroplasty Performed Due to Prosthetic
Przemysław Bereza1, Alicja Ekiel2, Małgorzata Aptekorz2
1Śląski Uniwersytet Medyczny w Katowicach, Wydział Nauk Medycznych w Katowicach, Polska / Medical University of Silesia, Faculty of Medical Sciences in Katowice, Poland Katedra i Klinika Ortopedii i Traumatologii Narządu Ruchu / Department of Orthopaedics and Traumatology.
Background:
Two-stage revision arthroplasty remains the main surgical strategy for the treatment of prosthetic joint infections (PJI). Sonicate fluid culture has improved sensitivity compared to standard periprosthetic tissue culture, but its usefulness is questionable during the second stage of revision arthroplasty.
Material And Methods:
Twenty-seven patients with prosthetic joint infection were investigated. Tissue and sonicate fluid cultures were examined to detect bacteria on the removed spacer during the second stage of exchange arthroplasty. Microbiological findings were analyzed and patients were assessed within an average of 5 years follow up.
Results:
Tissue cultures in second-stage revision arthroplasties were positive in 6/27 cases (22.2%) growing CNS in 4 cases (14.8%), Staphylococcus aureus in 1 case (3.7%), and Enterococcus faecalis in 1 case (3.7%). In 3 cases (11.1%) infection was identified as a result of a sonication procedure. Clinical failures at final follow-up were recorded in 4 (14.8%) patients, with reinfection noted in 3 of them. Arthrodesis and spacer exchange followed by suppressive antibiotic therapy were performed in 2 cases.
Conclusions:
1. Tissue cultures remain the gold standard in diagnosis of PIJ although a negative culture does not rule out the presence of bacteria on spacers removed during second stage revision for PJI. 2. Sonication appears to have limited ability to detect persistent infection before reimplantation and was not associated with recurrent infection; however, it can be considered a complementary method that could make it possible to identify new microorganisms and facilitate the selection of appropriate treatment options. 3. The positive results of sonication should be interpreted as the detection of actual pathogens in the light of the clinical, microbiological and histopathological data, especially for patients with immunodeficiency.
Insights
Tissue cultures are the gold standard for diagnosing prosthetic joint infections (PJI) during second-stage revision surgery. Sonication may help identify new pathogens but has limited ability to detect persistent infection.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Two-stage revision arthroplasty is the primary treatment for prosthetic joint infections (PJI).
- Sonicate fluid culture offers improved sensitivity over standard tissue culture for PJI diagnosis.
- The utility of sonicate fluid culture in the second stage of revision arthroplasty requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of tissue and sonicate fluid cultures in detecting bacteria on removed spacers during the second stage of revision arthroplasty for PJI.
- To correlate microbiological findings with clinical outcomes and reinfection rates.
Main Methods:
- A cohort of 27 patients with PJI undergoing second-stage revision arthroplasty was studied.
- Tissue and sonicate fluid samples from removed spacers were cultured for bacterial detection.
- Patients were followed for an average of 5 years to assess clinical outcomes and reinfection.
Main Results:
- Tissue cultures yielded positive results in 22.2% of cases, identifying Coagulase-Negative Staphylococci (CNS), Staphylococcus aureus, and Enterococcus faecalis.
- Sonication detected infection in 11.1% of cases.
- Clinical failures occurred in 14.8% of patients, with 3 experiencing reinfection.
Conclusions:
- Tissue cultures are the gold standard for PJI diagnosis, but a negative result does not exclude bacterial presence on spacers.
- Sonication has limited ability to detect persistent infection and was not associated with recurrent infection, but can aid in identifying new microorganisms.
- Positive sonication results should be interpreted in conjunction with clinical, microbiological, and histopathological data, especially in immunocompromised patients.
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