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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Intraoperative Direct Sonication of Implants and Soft Tissue for the Diagnosis of Periprosthetic Joint Infection
Baochao Ji1, Abudousaimi Aimaiti, Fei Wang
1Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
Background:
Sonication is very efficacious for the microbiological diagnosis of periprosthetic joint infection (PJI), but it involves many steps and multiple workplaces and personnel and therefore carries a potential contamination risk. We present an innovative version of the sonication culture method that involves direct sonication of the retrieved implant and soft tissue, without a sonication tube, intraoperatively and incubation using a BACT/ALERT 3D blood culture system to enhance the efficacy of microbiological diagnosis of PJI.
Methods:
We performed a prospective study of consecutive patients requiring implant removal and classified them as having PJI or aseptic failure according to standard criteria. The removed prosthetic components and adjacent soft tissue were directly sonicated in a small metal container, without a sonication tube, during the operation. The sonication fluid was immediately incubated in blood culture bottles in the operating room and cultured in the BACT/ALERT 3D blood culture system. The synovial fluid was also cultured in the BACT/ALERT 3D system to serve as a comparison.
Results:
Of the 64 included patients, 36 had PJI and 28 had aseptic failure. Fluid from direct sonication and conventional synovial fluid showed sensitivities of 91.7% and 55.6% (p < 0.001) and specificities of 82.1% and 92.9%, respectively. Fourteen cases of PJI were detected by culture of fluid from direct sonication but not by culture of synovial fluid. Higher sensitivity was obtained by direct sonication of only tissue than by direct sonication of only the implant (88.9% versus 75.0%). No significant difference in detection time was found between Staphylococcus aureus and coagulase-negative Staphylococcus.
Conclusions:
When combined with incubation in BACT/ALERT bottles, direct intraoperative sonication of implants and soft tissues without a sonication tube was more sensitive than conventional synovial fluid culture and could reliably and rapidly detect the bacteria commonly found in PJI.
Level Of Evidence:
Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Insights
Direct intraoperative sonication of implants and tissues improves periprosthetic joint infection (PJI) diagnosis. This enhanced method is more sensitive than traditional synovial fluid culture for detecting PJI pathogens.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnostics
- Microbiology
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on sonication, but it risks contamination.
- An innovative direct sonication method is presented to improve PJI diagnosis efficacy.
Purpose of the Study:
- To evaluate a novel direct intraoperative sonication technique for PJI microbiological diagnosis.
- To compare the diagnostic accuracy of direct sonication with conventional synovial fluid culture.
Main Methods:
- Prospective study of patients undergoing implant removal.
- Direct sonication of retrieved implants and soft tissues intraoperatively.
- Incubation of sonication fluid in BACT/ALERT 3D blood culture system.
Main Results:
- Direct sonication showed higher sensitivity (91.7%) than synovial fluid culture (55.6%) for PJI detection (p < 0.001).
- Fourteen PJI cases were identified by direct sonication alone.
- Direct sonication of tissue alone was more sensitive than sonication of the implant alone.
Conclusions:
- Direct intraoperative sonication combined with BACT/ALERT incubation offers superior sensitivity for PJI diagnosis.
- This method reliably and rapidly detects common PJI-causing bacteria.
- The technique reduces contamination risk compared to conventional methods.
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