Abstract
Periprosthetic joint infection (PJI) is a catastrophic complication following total joint arthroplasty. Until now, the diagnosis of PJI is still confronted with difficulties, which is characterized by technical limitations. The question of whether sonication fluid PCR can provide high value in the diagnosis of PJI remains unanswered. This meta-analysis included 9 studies that evaluated PCR assays of sonication fluid for the diagnosis of PJI. The pooled sensitivity, specificity, Positive likelihood ratio (PLR), Negative likelihood ratio (NLR) and Diagnostic odds ratio (DOR) were 0.75 (95% confidence interval [CI], 0.71 to 0.81), 0.96 (CI, 0.94 to 0.97), 18.24 (CI, 6.07 to 54.78), 0.27 (CI, 0.20 to 0.36) and 86.97 (CI, 37.08 to 203.97), respectively. The AUC value of the SROC was 0.9244 (standard error, 0.0212). Subgroup analyses showed that use of multiplex PCR and may improve sensitivity and specificity. The results of this meta-analysis showed that PCR of fluid after sonication is reliable and of great value in PJI diagnosis.
Highlights
The rise in the number of total joint arthroplasty performed worldwide could result in an increasing number of complications, the most catastrophe of these include periprosthetic joint infection (PJI), with an incidence of 1 to 12% [1,2]
We performed a literature search, screened the studies identified, and evaluated the studies that related to application of sonication fluid PCR in PJI diagnosis
Our reviewers independently evaluated the selected studies according to the following inclusion criteria: (1) the study assessed the accuracy of sonication fluid PCR for the diagnosis of PJI compared with the presence of a sinus tract communicating with the prosthesis, the visible purulence of the synovial fluid or surgical site, simultaneously obtained microbiological cultures from at least two periprosthetic tissue samples or acute inflammation in the histopathological periprosthetic tissue sections; (2) sufficient data were reported to allow the calculation of true-positive (TP), true-negative (TN), false-positive (FP), and false-negative (FN) values; (3) the study reported at least 10 patients, from which data extraction using our standardized data collection form
Summary
The rise in the number of total joint arthroplasty performed worldwide could result in an increasing number of complications, the most catastrophe of these include periprosthetic joint infection (PJI), with an incidence of 1 to 12% [1,2]. PJI poses a significant burden on patients, surgeons, and the healthcare economy. Treatment requires early detection and identification of the infectious agent. Diagnosis of infection is difficult and challenging in many cases [3]. Several studies have assessed the diagnostic value of PJI, including PCR techniques of implant sonication samples [4,5]. We performed a meta-analysis to evaluate the detection validity of sonication fluid PCR in the diagnosis of PJI to provide further evidence for its clinical use
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