Sonication: A Valuable Technique for Diagnosis and Treatment of Periprosthetic Joint Infections

D S Evangelopoulos,A Albarni,A Stylianakis,G P Morassi,J Vlamis,S Koufos,S Kohl,I P Stathopoulos,P K Karampinas,S Pneumaticos

doi:10.1155/2013/375140

Abstract

Background. Periprosthetic joint infection (PJI) is the most severe complication, following joint arthroplasty. Identification of the causal microbial factor is of paramount importance for the successful treatment. Purpose. The aim of this study is to compare the sonication fluid cultures derived from joint prosthetic components with the respective periprosthetic tissue cultures. Methods. Explanted prosthesis components for suspected infection were placed into a tank containing sterile Ringer's solution and sonicated for 1 minute at 40 kHz. Sonication fluid cultures were examined for 10 days, and the number and identity of any colony morphology was recorded. In addition, periprosthetic tissue specimens (>5) were collected and cultured according to standard practice. The duration of antimicrobial interruption interval before culture sampling was recorded. Results. Thirty-four patients composed the study group. Sonication fluid cultures were positive in 24 patients (70.5%). Sixteen of thirty four periprosthetic tissue cultures (47.1%) were considered positive, all revealing the same microbial species with the respective sonication fluid cultures: 3 tissue samples showed polymicrobial infection. All tissue cultures were also found positive by the sonication fluid culture. Conclusions. Sonication fluid cultures represent a cheap, easy, accurate, and sensitive diagnostic modality demonstrating increased sensitivity compared to periprosthetic tissue cultures (70.5 versus 47.1%).

Highlights

Over the last decades the number of total joint replacement procedures has been explosively increased with nearly 800.000 primary THR and TKR performed in the United States and 130.000 in England in 2006 [1, 2]
Periprosthetic joint infection (PJI) is the most severe complication, occurring in 0.3 to 1.7% of THR and 0.8 to 1.9% of TKR [4,5,6,7,8], while these rates rise up to 40% after revision surgery [9]. Their associated mortality is estimated to be between 1.0 and 2.7 percent [10,11,12]. They are still considered as an uncommon problem, PJIs pose a heavy social and economic burden with an estimated cost of up to $50.000 per patient and $250 million per year [10, 13], while others estimate that hospital costs per patient requiring revision THR due to infection reach nearly 5 times that of a primary THR [14]
Identification of the causal microbial factor is of paramount importance for successful treatment

Summary

Introduction

Over the last decades the number of total joint replacement procedures has been explosively increased with nearly 800.000 primary THR and TKR performed in the United States and 130.000 in England in 2006 [1, 2]. Periprosthetic joint infection (PJI) is the most severe complication, occurring in 0.3 to 1.7% of THR and 0.8 to 1.9% of TKR [4,5,6,7,8], while these rates rise up to 40% after revision surgery [9]. Their associated mortality is estimated to be between 1.0 and 2.7 percent [10,11,12]. Sixteen of thirty four periprosthetic tissue cultures (47.1%) were considered positive, all revealing the same microbial species with the respective sonication fluid cultures: 3 tissue samples showed polymicrobial infection. Sonication fluid cultures represent a cheap, easy, accurate, and sensitive diagnostic modality demonstrating increased sensitivity compared to periprosthetic tissue cultures (70.5 versus 47.1%)

Objectives

Methods

Conclusion