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Updated: Sep 8, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Optimal selection of specimens for metagenomic next-generation sequencing in diagnosing periprosthetic joint
Jun Tan1, Lingxiao Wu2, Lijuan Zhan3
1Department of Mini-invasive Spinal Surgery, The Third People's Hospital of Henan Province, Zhengzhou, Henan, China.
Objective:
This study aimed to assess the diagnostic value of metagenomic next-generation sequencing (mNGS) across synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues among patients with periprosthetic joint infection (PJI), intending to optimize specimen selection for mNGS in these patients.
Methods:
This prospective study involved 61 patients undergoing revision arthroplasty between September 2021 and September 2022 at the First Affiliated Hospital of Zhengzhou University. Among them, 43 cases were diagnosed as PJI, and 18 as aseptic loosening (AL) based on the American Musculoskeletal Infection Society (MSIS) criteria. Preoperative or intraoperative synovial fluid, periprosthetic tissues, and prosthetic sonicate fluid were collected, each divided into two portions for mNGS and culture. Comparative analyses were conducted between the microbiological results and diagnostic efficacy derived from mNGS and culture tests. Furthermore, the variability in mNGS diagnostic efficacy for PJI across different specimen types was assessed.
Results:
The sensitivity and specificity of mNGS diagnosis was 93% and 94.4% for all types of PJI specimens; the sensitivity and specificity of culture diagnosis was 72.1% and 100%, respectively. The diagnostic sensitivity of mNGS was significantly higher than that of culture (X2 = 6.541, P=0.011), with no statistically significant difference in specificity (X2 = 1.029, P=0.310). The sensitivity of the synovial fluid was 83.7% and the specificity was 94.4%; the sensitivity of the prosthetic sonicate fluid was 90.7% and the specificity was 94.4%; and the sensitivity of the periprosthetic tissue was 81.4% and the specificity was 100%. Notably, the mNGS of prosthetic sonicate fluid displayed a superior pathogen detection rate compared to other specimen types.
Conclusion:
mNGS can function as a precise diagnostic tool for identifying pathogens in PJI patients using three types of specimens. Due to its superior ability in pathogen identification, prosthetic sonicate fluid can replace synovial fluid and periprosthetic tissue as the optimal sample choice for mNGS.
Insights
Metagenomic next-generation sequencing (mNGS) accurately diagnoses periprosthetic joint infection (PJI). Prosthetic sonicate fluid is the optimal specimen for mNGS, offering superior pathogen detection over synovial fluid and periprosthetic tissues.
Area of Science:
- Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Periprosthetic joint infection (PJI) is a serious complication following arthroplasty.
- Accurate and timely diagnosis of PJI is crucial for effective treatment and patient outcomes.
- Current diagnostic methods, including microbial culture, have limitations in sensitivity and specificity.
Purpose of the Study:
- To evaluate the diagnostic performance of metagenomic next-generation sequencing (mNGS) for PJI.
- To compare the efficacy of mNGS using synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues.
- To determine the optimal specimen type for mNGS-based PJI diagnosis.
Main Methods:
- A prospective study involving 61 patients undergoing revision arthroplasty.
- Collection of synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues from patients diagnosed with PJI or aseptic loosening (AL).
- Comparative analysis of mNGS and conventional culture methods for pathogen detection and diagnostic accuracy.
Main Results:
- mNGS demonstrated high sensitivity (93%) and specificity (94.4%) for PJI diagnosis across all specimen types.
- mNGS showed significantly higher sensitivity than culture (93% vs. 72.1%, P=0.011).
- Prosthetic sonicate fluid yielded the highest pathogen detection rate with mNGS, suggesting it as the optimal specimen.
Conclusions:
- mNGS is a precise diagnostic tool for identifying pathogens in PJI.
- Prosthetic sonicate fluid is recommended as the preferred specimen for mNGS in PJI diagnosis due to its superior pathogen detection capabilities.
- Optimizing specimen selection enhances the diagnostic value of mNGS for PJI.
