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Sonication in shoulder surgery: is it necessary?

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Abstract

Purpose

The objective of the present study was to determine whether sonication yields greater sensitivity when compared with the traditional tissue culture in detecting peri-implant infections in shoulder surgery.

Methods

It is a retrospective study that includes 99 shoulder surgeries with implants explanted. The inclusion criteria required at least four tissue cultures, sonication of the material explanted, and a minimum follow-up of two years. Patients were classified according to the definition of periprosthetic shoulder infection of the 2018 International Consensus Meeting on Orthopedic Infections. The classifications are definitive infection, probable infection, possible infection, and unlikely infection.

Results

Among the 99 surgical procedures, 31 were considered definitive infections, 11 possible/probable infections, and 57 unlikely infections. Considering the cases with a definitive infection, the sensitivity of the tissue culture was 87.09% and the sensitivity of sonication stood at 80.64% (p = 0.406). Analyzing the cases with a definitive infection and those having a possible/probable infection together and comparing them with those with unlikely infection, the sensitivity of sonication was 80.4% and the sensitivity of the tissue culture came to 91.4%. The specificity of the sonication was 98.1% and the specificity of the tissue culture was 99.6%.

Conclusion

The sensitivity of sonication in shoulder surgery (80.64%) is not superior to the sensitivity of the tissue culture (87.09%). Specificity remains high with both methods, being 98.1% in the sonication group and 99.6% in the tissue culture. Sonication brings no benefit to the detection of shoulder per-implant infections.

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Acknowledgments

The author’s wish to thank Xavier Duran Jordà, MStat, PhD (Methodology and Biostatistics Support Unit, Institute Hospital del Mar for Medical Research (IMIM), Barcelona, Spain) for his work in data analysis.

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Authors and Affiliations

  1. Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25–29, 08003, Barcelona, Spain

    Carlos Torrens, Anna Fraile, Fernando Santana, Lluis Puig & Albert Alier

Authors
  1. Carlos Torrens
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  2. Anna Fraile
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  3. Fernando Santana
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  4. Lluis Puig
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  5. Albert Alier
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Contributions

CT has conceptualized and designed the study, analyzed and interpreted the data, and drafted the manuscript; AF has collected data, analyzed and interpreted the data, and revised the manuscript; FS has collected data, analyzed and interpreted the data, and revised the manuscript; LLP has collected data, analyzed and interpreted the data, and revised the manuscript; AA has conceptualized and designed the study, has collected data, analyzed and interpreted the data, and revised the manuscript. All authors have approved the final manuscript as submitted.

Corresponding author

Correspondence to Carlos Torrens.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the ethical committee with number 2019/8493/I (CEIC-Parc de Salut Mar) and all patients involved signed informed consent.

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Torrens, C., Fraile, A., Santana, F. et al. Sonication in shoulder surgery: is it necessary?. International Orthopaedics (SICOT) 44, 1755–1759 (2020). https://doi.org/10.1007/s00264-020-04543-8

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  • DOI: https://doi.org/10.1007/s00264-020-04543-8

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