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Published on: December 3, 2017
Evaluating the Clinical Relevance of Routine Sonication for Periprosthetic Hip or Knee Joint Infection Diagnosis
Anas Zouitni1, Jakob van Oldenrijk1, P Koen Bos1
1Department of Orthopedic Surgery and Sports Medicine, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands.
Abstract:
Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty. PJI screening and conventional cultures may be inconclusive. Sonication fluid culturing stands out as a valuable adjunct technique for PJI diagnosis. This study aims to determine the clinical relevance of routine sonication for all (a)septic revisions. All patients who underwent (partial) hip or knee revision arthroplasty between 2012 and 2021 were retrospectively reviewed. We formed three groups based on the European Bone and Joint Society PJI criteria: infection confirmed, likely, and unlikely. We analyzed clinical, laboratory, and radiological screening. Sensitivity and specificity were calculated for synovial fluid (preoperative), tissue, and sonication fluid cultures. We determined the clinical relevance of sonication as the percentage of patients for whom sonication confirmed PJI; 429 patients who underwent (partial) revision of hip or knee arthroplasty were included. Sensitivity and specificity were 69% and 99% for synovial fluid cultures, 76% and 92% for tissue cultures, and 80% and 89% for sonication fluid cultures, respectively. Sonication fluid cultures improved tissue culture sensitivity and specificity to 83% and 99%, respectively. In 11% of PJIs, sonication fluid cultures were decisive for diagnosis. This is applicable to acute and chronic infections. Sonication fluid cultures enhanced the sensitivity and specificity of PJI diagnostics. In 11% of PJI cases, causative pathogens were confirmed by sonication fluid culture results. Sonication fluid culture should be performed in all revision arthroplasties.
Insights
Sonication fluid culturing is a valuable tool for diagnosing periprosthetic joint infection (PJI) in revision arthroplasty. This method enhances diagnostic accuracy and should be routinely performed for all revision surgeries.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Diagnostic Microbiology
Background:
- Periprosthetic joint infection (PJI) is a significant complication following joint replacement surgery.
- Conventional diagnostic methods for PJI, including screening and cultures, can be inconclusive.
- Sonication fluid culturing offers a promising adjunct for improving PJI diagnosis.
Purpose of the Study:
- To evaluate the clinical relevance and diagnostic performance of routine sonication fluid culturing in patients undergoing revision arthroplasty.
- To compare the sensitivity and specificity of sonication fluid cultures with preoperative synovial fluid and intraoperative tissue cultures for PJI diagnosis.
Main Methods:
- Retrospective review of 429 patients undergoing hip or knee revision arthroplasty between 2012 and 2021.
- Classification of patients into infection confirmed, likely, and unlikely groups based on European Bone and Joint Infection Society criteria.
- Calculation of sensitivity and specificity for synovial fluid, tissue, and sonication fluid cultures.
Main Results:
- Sonication fluid cultures demonstrated high sensitivity (80%) and specificity (89%) for PJI diagnosis.
- Combining sonication fluid cultures with tissue cultures improved sensitivity to 83% and specificity to 99%.
- Sonication fluid cultures were decisive in confirming PJI in 11% of cases, applicable to both acute and chronic infections.
Conclusions:
- Sonication fluid culturing significantly enhances the sensitivity and specificity of periprosthetic joint infection diagnostics.
- Routine sonication fluid culture should be considered for all revision arthroplasties to improve PJI diagnosis.
- This technique is crucial for identifying causative pathogens in a substantial proportion of PJI cases.
