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Updated: Jan 14, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Comparative diagnostic accuracy of next-generation sequencing in different specimen types for periprosthetic joint
Lina Wang1, Shangxiang Feng2, Zhongyuan Zhao2
1Department of Infectious Diseases, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Purpose:
Discrepancies in next-generation sequencing (NGS) results across synovial fluid, periprosthetic tissues and implant sonicate fluid pose a significant clinical challenge in diagnosing periprosthetic joint infection (PJI). We conducted a systematic review and meta-analysis to compare the diagnostic accuracy of these NGS sample types for PJI.
Methods:
This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted in PubMed, EMBASE and the Cochrane Library databases from inception to 1 June 2025. Two independent reviewers performed data extraction and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. For each specimen type, we estimated the pooled sensitivity and specificity, summary receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC).
Results:
Following screening, 18 studies were included. Pooled sensitivities of NGS for PJI diagnosis were as follows: synovial fluid 0.86 (95% confidence interval [CI]: 0.79-0.91), periprosthetic tissue 0.86 (95% CI: 0.69-0.95) and sonicate fluid 0.89 (95% CI: 0.77-0.95). Corresponding specificities were 0.94 (95% CI: 0.91-0.96), 0.98 (95% CI: 0.85-1.00) and 0.96 (95% CI: 0.91-0.98). AUCs were 0.93 (0.89-0.95), 0.96 (0.88-0.97) and 0.96 (0.88-0.97), respectively. Pairwise comparisons of AUCs showed no statistically significant differences (p > 0.05).
Conclusions:
This meta-analysis suggests that NGS of sonicate fluid demonstrates higher sensitivity compared to NGS of synovial fluid or periprosthetic tissue, while maintaining strong specificity, making it valuable for detecting infection. Periprosthetic tissue NGS demonstrated exceptional specificity and acceptable sensitivity, making it valuable for confirming infection. All specimens show clinically useful AUC values. Sonicate fluid shows promise, but specimen selection warrants careful consideration of the sensitivity-specificity trade-off in clinical practice and requires validation of clinical utility due to the absence of a perfect PJI diagnostic gold standard and the risk of false positives.
Level Of Evidence:
Level II.
Insights
Next-generation sequencing (NGS) of implant sonicate fluid shows high sensitivity for diagnosing periprosthetic joint infection (PJI), while periprosthetic tissue NGS offers excellent specificity. Both methods are valuable for PJI diagnosis, with careful consideration of trade-offs.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Molecular Diagnostics
Background:
- Diagnosing periprosthetic joint infection (PJI) is challenging due to inconsistent results from next-generation sequencing (NGS) across different sample types.
- Synovial fluid, periprosthetic tissues, and implant sonicate fluid are commonly used for NGS-based PJI detection, but their comparative accuracy is not well-established.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of NGS for periprosthetic joint infection (PJI) using synovial fluid, periprosthetic tissues, and implant sonicate fluid.
- To compare the sensitivity, specificity, and overall diagnostic performance of these different sample types for PJI.
Main Methods:
- Adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Comprehensive literature search of PubMed, EMBASE, and Cochrane Library databases up to June 1, 2025.
- Data extraction and quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool; estimation of pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUC) for each specimen type.
Main Results:
- Eighteen studies were included in the meta-analysis.
- Pooled sensitivities for NGS were: sonicate fluid (0.89), synovial fluid (0.86), and periprosthetic tissue (0.86).
- Pooled specificities were: periprosthetic tissue (0.98), sonicate fluid (0.96), and synovial fluid (0.94). Areas under the SROC curves (AUCs) were comparable across all specimen types (0.93-0.96), with no statistically significant differences.
Conclusions:
- Next-generation sequencing (NGS) of implant sonicate fluid offers the highest sensitivity for periprosthetic joint infection (PJI) diagnosis, while periprosthetic tissue NGS provides exceptional specificity.
- All tested specimen types (synovial fluid, periprosthetic tissue, sonicate fluid) demonstrate clinically useful diagnostic accuracy (AUC values).
- Specimen selection for NGS in PJI diagnosis requires careful consideration of the sensitivity-specificity trade-off and validation of clinical utility, given the lack of a perfect gold standard and potential for false positives.
