Abstract
Aim
Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty. Diagnosing PJI can be challenging as preoperative screening and conventional cultures may be inconclusive. Sonication fluid culturing stands out as a valuable adjunct technique to improve microbiological PJI diagnosis. This study aims to determine the clinical relevance of routinely using sonication for all septic and aseptic revisions.
Method
All patients who underwent (partial) hip or knee revision arthroplasty for all causes between 2012 and 2021 at our institution were retrospectively reviewed. Based on the European Bone and Joint Society PJI criteria, we categorized them into three groups: infection confirmed, infection likely, and infection unlikely. We analyzed the clinical, laboratory, and radiological screening that could confirm or refute suspicion of PJI. We analyzed microbiology cultures and the most frequently detected microorganisms. Sensitivity and specificity were calculated for synovial fluid cultures (preoperative), tissue cultures, and sonication fluid cultures. We determined the clinical relevance of sonication as the percentage of patients for whom sonication confirmed (microbiological) PJI diagnosis.
Results
429 patients who underwent (partial) revision of hip (246 patients) or knee (183 patients) arthroplasty were included. Sensitivity and specificity were 69% and 99% for preoperative synovial fluid cultures, 76% and 92% for intraoperative tissue cultures, and 80% and 89% for sonication fluid cultures, respectively. Sonication fluid cultures improved tissue culture sensitivity and specificity to 83% and 99%, respectively. In 12 (11%) out of 110 PJIs, sonication fluid cultures were decisive for confirming the causative pathogen. This was applicable to acute and chronic infections. In 29 (9%) out of 319 aseptic cases, a negative sonication fluid culture could confirm contamination of tissue cultures.
Conclusions
Routine sonication fluid cultures enhanced the sensitivity and specificity of PJI diagnostics. In 11% of PJI cases, causative pathogens were confirmed by sonication fluid culture results. Routine sonication may be helpful in confirming contamination of synovial fluid cultures and tissue cultures. Routine sonication fluid culture should be performed in all revision arthroplasties.
