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Updated: Jun 15, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Molecular diagnostics for perioperative microbial identification in periprosthetic joint infection: A scoping review
Pier Francesco Indelli1,2, Trifon Totlis1,3, Bruno Lovreković2,4
1European Society of Sports Traumatology, Knee Surgery Arthroscopy (ESSKA) - European Knee Associates (EKA) Board Luxembourg Luxembourg.
Purpose:
Periprosthetic joint infections (PJI) are among the most feared complications of joint reconstruction. Unfortunately, traditional cultures often fail to identify the aetiological agents of PJI. Molecular diagnostics can overcome the limitations of standard synovial fluid culture by utilising information from DNA/RNA samples to identify microbial species. The authors conducted a scoping review to evaluate the current state regarding the use of molecular diagnostics in the decision-making process for the surgical treatment of PJI and to create a flowchart based on molecular diagnostics.
Methods:
A scoping review was conducted to provide an overview of the literature on molecular diagnostic techniques for detecting perioperative microbial infections in PJI. The population considered included patients undergoing total hip or knee arthroplasty or replacement, with a focus on molecular diagnostic methods within the perioperative period. The database search encompassed PubMed, Embase, Scopus and the Cochrane Library.
Results:
Seventy-five articles were included after a preliminary review of 1315 records. Each article was assigned to one of four categories to fulfil the purpose of this review: (1) Polymerase chain reaction (PCR) related studies: n = 18; (2) Next-Generation-Sequencing (NGS) related studies: n = 40; (3) comparative studies, including systematic reviews and meta-analyses, between different molecular diagnostic methodologies: n = 7; and (4) general reviews on nucleic acid-based strategies to detect PJIs: n = 10.
Conclusions:
This review confirmed that molecular diagnostics are becoming extremely valuable tools in the decision-making process for PJI treatment. Culture-based techniques still represent the gold standard in PJI microorganism identification, but our review showed that standard culture, in 2025, could be integrated with newer nucleic acid-based strategies.
Level Of Evidence:
Level I.
Insights
Molecular diagnostics offer a valuable alternative to traditional cultures for identifying causative agents in periprosthetic joint infections (PJI). Integrating these nucleic acid-based strategies with standard cultures can improve PJI treatment decisions.
Area of Science:
- Orthopedics
- Infectious Diseases
- Molecular Diagnostics
Background:
- Periprosthetic joint infections (PJI) are severe complications following joint replacement surgery.
- Traditional culture methods often fail to accurately identify the causative microorganisms in PJI.
- Molecular diagnostics utilize DNA/RNA analysis to detect microbial species, overcoming culture limitations.
Purpose of the Study:
- To conduct a scoping review on molecular diagnostic techniques for PJI.
- To evaluate the role of molecular diagnostics in surgical treatment decision-making for PJI.
- To develop a flowchart for PJI management based on molecular diagnostics.
Main Methods:
- A scoping review of the literature was performed.
- Searches were conducted in PubMed, Embase, Scopus, and the Cochrane Library.
- Included studies focused on molecular diagnostic methods for perioperative microbial infections in hip or knee arthroplasty patients.
Main Results:
- Seventy-five articles were included, categorized into PCR (18), Next-Generation Sequencing (40), comparative studies (7), and general reviews (10).
- Molecular diagnostics are increasingly valuable for PJI treatment decisions.
- Next-Generation Sequencing was the most frequently studied molecular method.
Conclusions:
- Molecular diagnostics are becoming essential tools in managing PJI.
- While culture remains the gold standard, nucleic acid-based strategies can complement it.
- Integration of molecular diagnostics with standard cultures is feasible and recommended for PJI management in 2025.
