Abstract
Despite its decreasing incidence, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of sonication fluid of the explanted hardware and to investigate the role of patientrelated factors affecting the sensitivity of the sonication method. We investigated 70 patients undergoing revision hip or knee arthroplasty, at our institution. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip prostheses and 22 knee prostheses). The sensitivities of sonication fluid culture and conventional tissue cultures were 81.25% and 56.25%, respectively (p-value = 0.043). The sensitivity of the sonication method was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis (p-values < 0.05). The sonication method has a greater sensitivity than the conventional periprosthetic tissue cultures for the periprosthetic infections, especially in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis.
Highlights
Total hip and knee replacements are two of the most common orthopedic surgical procedures
Periprosthetic joint infection (PJI) is the most challenging complication associated with total joint arthroplasty [1]
The microbiological diagnosis of PJI has been based on periprosthetic tissue cultures (PTC)
Summary
Total hip and knee replacements are two of the most common orthopedic surgical procedures. Periprosthetic joint infection (PJI) is the most challenging complication associated with total joint arthroplasty [1]. Despite considerable progress in prevention and treatment of PJIs, the absolute number of patients with such infections is rising due to the lifelong risk for bacterial seeding of the implant [2]. In patients with primary knee replacement, the infection rate has been reported to be 0,8 to 3,3%, and in those with hip replacement is 0,3% to 3,0%. PJI is considered to be associated with the presence of bacterial biofilms attached to the implant, where the bacteria have changed their phenotypes to an extremely resistant form of life [6]. The microbiological diagnosis of PJI has been based on periprosthetic tissue cultures (PTC).
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