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Updated: Jun 30, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Differences in Diagnostic Sensitivity of Cultures Between Sample Types in Periprosthetic Joint Infections: A
Shintaro Watanabe1, Emi Kamono2, Hyonmin Choe1
1Department of Orthopedic Surgery, Yokohama City University, Yokohama, Japan.
Background:
Differences between the bacterial culture results of the preoperative fluid, intraoperative tissue, and sonication fluid of implants in the diagnosis of periprosthetic joint infection (PJI) are important issues in clinical practice. This study aimed to identify the differences in pooled diagnostic accuracy between culture sample types for diagnosing PJI by performing a systematic review and meta-analysis.
Methods:
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. A comprehensive literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases was performed. Data extraction and study assessment using the quality assessment of diagnostic accuracy studies were performed independently by two reviewers. The pooled sensitivity, specificity, summary receiver operating characteristic curve, and area under the summary receiver operating characteristic curve were estimated for each sample type.
Results:
There were thirty-two studies that were included in the analysis after screening and eligibility assessment. The pooled sensitivities of preoperative fluid, intraoperative tissue, and sonication fluid for the diagnosis of PJI were 0.63 (95% confidence interval [CI] 0.56 to 0.70), 0.71 (95% CI 0.63 to 0.79), and 0.78 (95% CI 0.68 to 0.85), while the specificities were 0.96 (95% CI 0.93 to 0.98), 0.92 (95% CI 0.86 to 0.96), and 0.91 (95% CI 0.83 to 0.95), respectively. The area under the curves for preoperative fluid, intraoperative tissue, and sonication fluid were 0.86, 0.88, and 0.90, respectively.
Conclusions:
Sonication fluid culture demonstrated better sensitivity compared with the conventional culture method, and preoperative fluid culture provided lower sensitivity in diagnosing PJI.
Insights
Sonication fluid culture offers superior sensitivity for diagnosing periprosthetic joint infection (PJI) compared to traditional methods. Preoperative fluid culture shows lower sensitivity in PJI diagnosis.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on bacterial cultures from various sample types.
- Differences in diagnostic accuracy between preoperative fluid, intraoperative tissue, and implant sonication fluid are clinically significant.
Purpose of the Study:
- To systematically review and meta-analyze the pooled diagnostic accuracy of different culture sample types for PJI.
- To compare the effectiveness of preoperative fluid, intraoperative tissue, and sonication fluid in PJI diagnosis.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Comprehensive literature search across PubMed, CINAHL, and Cochrane Library.
- Independent data extraction and quality assessment using the QUADAS tool.
Main Results:
- Thirty-two studies were included in the meta-analysis.
- Pooled sensitivities for PJI diagnosis: preoperative fluid (0.63), intraoperative tissue (0.71), and sonication fluid (0.78).
- Pooled specificities: preoperative fluid (0.96), intraoperative tissue (0.92), and sonication fluid (0.91). Area under the curve (AUC) values were 0.86, 0.88, and 0.90, respectively.
Conclusions:
- Sonication fluid culture exhibits higher sensitivity for diagnosing PJI than conventional methods.
- Preoperative fluid culture demonstrates lower sensitivity in PJI diagnosis.
- Sonication fluid culture is a valuable tool for improving PJI diagnostic accuracy.
