Diagnostic Test Analysis of Intraoperative Direct Sonication in Detecting Periprosthetic Joint Infection: A...

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Diagnostic Microbiology

Background:

• Periprosthetic joint infection (PJI) is a significant complication following arthroplasty.
• Current diagnostic methods for PJI can be limited by biofilm interference.
• Intraoperative direct sonication is a novel technique to enhance pathogen detection.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic accuracy of intraoperative direct sonication for suspected PJI.
• To evaluate the effectiveness of sonication in disrupting bacterial biofilms on explanted components and tissues.

Main Methods:

• A systematic literature search was conducted across multiple databases (CENTRAL, MEDLINE, Embase) and trial registries.
• Six studies were included, with four unique datasets analyzed; two studies (n=479) using MSIS 2011 criteria were pooled for meta-analysis.
• Hierarchical models were used to synthesize sensitivity and specificity, with risk of bias assessed using QUADAS-2.

Main Results:

• The pooled analysis of two studies demonstrated a summary sensitivity of 88.7% (95% CI, 82.9-92.7) and specificity of 83.1% (95% CI, 73.5-89.7).
• The risk of bias was generally low, with one study having unclear patient selection criteria.
• The search identified 1,910 records plus 124 from other sources, with six studies meeting inclusion criteria.

Conclusions:

• Intraoperative direct sonication exhibits promising diagnostic performance for identifying PJI.
• The current evidence base is limited to two studies using the MSIS reference standard.
• Larger, multicenter studies with consistent reference standards are required to confirm accuracy and establish the role of sonication in PJI diagnostics.