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Updated: Jun 10, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Next generation sequencing identifies an increased diversity of microbes in post lavage specimens in infected TKA
Madhav Chowdhry1, Matthew V Dipane2, Stephen T Duncan3
1Nuffield Department of Primary Care Health Sciences & Department of Continuing Education, Kellogg College, University of Oxford, UK.
Background:
Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty. In chronic PJI, a biofilm envelops the surface of implants, which contains microbiota within an extra-microbial polymeric matrix (EMPM). Microbial identification is paramount for effective treatment. In this study, we use a multi-modal, EMPM disrupting, neoadjuvant irrigant and compare the microbiota detected pre-lavage to post-lavage by two techniques: culture and Next Generation Sequencing (NGS). We suspect more organisms to be identified after applying an EMPM disrupting irrigant.
Methods:
A multicenter, prospective study was conducted on 38 patients with known Total Knee Arthroplasty PJI. At initial arthrotomy, synovial fluid was obtained and analyzed for quantitative cultures and microbial NGS. Joint was then irrigated with Bactisure Lavage followed by Normal Saline. Post-lavage samples were similarly obtained and analyzed.
Results:
In pre-lavage samples for cultures, 55.3% of samples were positive, identifying 11 unique organisms. In post-lavage samples for cultures, 13.2% of samples were positive, identifying 5 unique organisms. In pre-lavage samples for NGS, 79% were DNA signal positive, identifying 126 unique organisms. In post-lavage samples for NGS, 74% of samples were DNA signal positive, identifying 177 unique organisms. Moreover, 135/177 of these organisms were not identified pre-lavage.
Conclusion:
In this pre-to-post irrigant study, culture showed a decrease in the number of identifiable organisms post-lavage. In contrast NGS revealed an increase in the number of identifiable organisms post-lavage. Furthermore, NGS identified 135 additional organisms, not detected pre-lavage. This suggests an increased diversity of microbes may exist within EMPM, which are not cultivable.
Insights
Next Generation Sequencing (NGS) identified significantly more microbes in periprosthetic joint infection (PJI) biofilms after using a novel irrigant. This EMPM-disrupting lavage enhances microbial detection compared to traditional culture methods.
Area of Science:
- Microbiology
- Orthopedic Surgery
- Infectious Diseases
Background:
- Periprosthetic joint infection (PJI) is a severe complication of joint replacement surgery.
- Chronic PJI involves a biofilm with an extra-microbial polymeric matrix (EMPM) encasing implant surfaces.
- Accurate microbial identification is crucial for effective PJI treatment.
Purpose of the Study:
- To evaluate the impact of a novel EMPM-disrupting irrigant on microbial detection in PJI.
- To compare microbial identification using culture versus Next Generation Sequencing (NGS) pre- and post-irrigation.
Main Methods:
- A prospective study involving 38 patients with Total Knee Arthroplasty PJI.
- Synovial fluid samples were collected pre- and post-irrigation with a specialized lavage solution.
- Microbiota analysis was performed using both traditional culture and NGS techniques.
Main Results:
- Culture methods showed a decrease in detected organisms post-irrigation (55.3% to 13.2%).
- NGS detected a higher number of organisms post-irrigation (79% to 74% DNA signal positive) compared to pre-irrigation.
- NGS identified 135 additional organisms post-irrigation that were not detected by pre-irrigation methods.
Conclusions:
- The EMPM-disrupting irrigant enhanced microbial detection by NGS.
- NGS offers superior sensitivity for identifying diverse microbial communities within PJI biofilms.
- A significant portion of the PJI microbiota may be non-culturable and detectable only by advanced methods like NGS.
