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Updated: Jul 20, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Is an isolated positive sonication fluid culture in revision arthroplasties clinically relevant?
Christien Rondaan1, Alessandra Maso2, Rares-Mircea Birlutiu3
1Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Objectives:
The aim of this study was to investigate the clinical relevance of an isolated positive sonication fluid culture (SFC) in patients who underwent revision surgery of a prosthetic joint. We hypothesized that cases with a positive SFC have a higher rate of infection during follow-up compared with controls with a negative SFC.
Methods:
This retrospective multicentre observational study was performed within the European Study Group of Implant-Associated Infections. All patients who underwent revision surgery of a prosthetic joint between 2013 and 2019 and had a minimum follow-up of 1 year were included. Patients with positive tissue cultures or synovial fluid cultures were excluded from the study.
Results:
A total of 95 cases (positive SFC) and 201 controls (negative SFC) were included. Infection during follow-up occurred in 12 of 95 cases (12.6%) versus 14 of 201 controls (7.0%) (p = 0.125). In all, 79.8% of cases were with treated with antibiotics (76/95). Of the non-treated cases, 89% (17/19) had a positive SFC with a low virulent microorganism. When solely analysing patients who were not treated with antibiotics, 16% of the cases (3/19) had an infection during follow-up versus 5% of the controls (9/173) (p = 0.08).
Discussion:
Although not statistically significant, infections were almost twice as frequent in patients with an isolated positive SFC. These findings require further exploration in larger trials and to conclude about the potential benefit of antibiotic treatment in these cases.
Insights
An isolated positive sonication fluid culture (SFC) after prosthetic joint revision surgery may indicate a higher infection risk. Further research is needed to confirm this finding and assess antibiotic treatment benefits in these cases.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Prosthetic joint infections (PJIs) are a significant complication following joint replacement surgery.
- Revision surgery for PJIs often involves complex management strategies.
- The role of sonication fluid culture (SFC) in diagnosing PJIs is established, but the significance of an isolated positive SFC requires further clarification.
Purpose of the Study:
- To evaluate the clinical relevance of an isolated positive sonication fluid culture (SFC) in patients undergoing revision surgery for prosthetic joints.
- To determine if an isolated positive SFC is associated with an increased risk of subsequent infection compared to negative SFC.
Main Methods:
- Retrospective, multicentre observational study.
- Included patients undergoing revision surgery for prosthetic joints between 2013-2019 with at least 1-year follow-up.
- Excluded patients with positive tissue or synovial fluid cultures; focus on isolated positive SFC.
Main Results:
- 95 cases with positive SFC and 201 controls with negative SFC were analyzed.
- Infection during follow-up occurred in 12.6% of positive SFC cases versus 7.0% of negative SFC controls (p=0.125).
- Among untreated patients, 16% of positive SFC cases developed infection versus 5% of controls (p=0.08).
Conclusions:
- Infections were nearly twice as common in patients with an isolated positive SFC, though not statistically significant.
- These findings suggest a potential increased risk of infection associated with isolated positive SFC.
- Larger trials are warranted to confirm these results and investigate the potential benefit of antibiotic therapy in such cases.
