Joint replacement is a life-enhancing, cost-effective surgical intervention widely used to treat disabling joint pain mainly caused by osteoarthritis. Hip and knee joint replacements are common, highly successful operations bringing many patients relief from pain, and improve mobility.

Prosthetic joint infections (PJI) are often difficult to diagnose; diagnosis often relying on a combination of clinical findings, microbiological data and histological evaluation of periprosthetic tissue. The majority of recent studies demonstrate a higher sensitivity for the culture of sonication fluid (62–94%) than periprosthetic tissue (55–88%).

The Royal Devon & Exeter NHS Foundation Trust provided a specialist multidisciplinary team. We evaluated the use of sonication for identifying pathogens during revision hip and knee replacement in our unit with the intention of applying for further grants to study this technology in more detail; it was a diagnostic feasibility study. The target recruitment was 50 patients; 25 consecutive patients undergoing revision hip arthroplasty for any reason, and 25 undergoing revision knee arthroplasty for any reason. The majority of patients were identified in outpatient clinics.

Our results show that tissue culture remains more sensitive than sonication. The sensitivity for direct sonication was 75% compared with 80% for tissue culture; sensitivity of enriched sonication was 80 %, compared to the unit results for tissue culture of 83%. The combined sensitivity of tissue culture was better as a higher number of tissue specimens were obtained.

The different methodology might explain reported differences between this and other studies; however, our study does not support the use of sonication as the only tool in the diagnosis of PJI.