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Updated: Jan 8, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Evaluating Contamination Risk When Aspirating a Prosthetic Joint Using Microbial Next-Generation DNA Sequencing: An
Edward J McPherson1, Madhav Chowdhry, Devin R Young
1From the Departmenrt of Orthopaedic Surgery, David Geffen School of Medicine, UCLA, Los Angeles, CA (Dr. McPherson and Dr. Stavrakis); the Nuffield Department of Primary Care Health Sciences and Department of Continuing Education, Kellogg College, University of Oxford, Oxford, United Kingdom (Dr. Chowdhry); and the Oakland University William Beaumont School of Medicine, Rochester, MI (Mr. Young).
Background:
A challenge in periprosthetic joint infection is the detection of microbiota. Next-generation sequencing (NGS) of microbial ribosomal DNA is one detection method, but false-positive results are of concern. We conducted a simulated joint aspiration study to assess false-positive rates with NGS testing.
Methods:
The simulated joint was a 50-mL bottle of sterile saline. Four techniques (n = 20 per technique) were tested. Fluid aspirates were inserted into sterile vacutainers with different needle exchanges analyzed for potential contamination points. The negative control group (n = 20 per technique) consisted of 80 sterile saline bottles tested directly at the NGS laboratory.
Results:
Eighty simulated aspirations were performed, two NGS tests per "joint." In three simulated techniques, the positive detection rate was 0.8%. In the fourth technique, where 10 mL of ambient air was aspirated into the syringe, the rate was 10%. The positive detection rate among the negative control bottles was 1.2%.
Conclusion:
NGS detected DNA signals from sterile saline aspirations using a sterile technique. However, the false-positive rate was low (0.8%). We theorize that positive DNA signals originated from errant microbe contamination from ambient air drawn into the testing needle bore. We advocate needle exchange at every fluid transfer point.
