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Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis

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A Correction to this article was published on 24 March 2022

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Abstract

Purpose

Even though effective techniques in diagnosis of periprosthetic joint infections (PJIs) have been developed, the optimal modality has yet to be determined. The present meta-analysis aimed to compare the diagnostic accuracy of dithiothreitol (DTT) and sonication against the Musculoskeletal Infection Society criteria in patients undergoing revision joint surgery.

Methods

We searched the PubMed, Scopus, and Central Cochrane register of controlled trials as well as gray literature until the 9th of November, 2021. We included articles considering the comparative diagnostic accuracy of sonication and DTT in adult patients having revision hip and knee arthroplasty for septic or aseptic reasons. We calculated pooled sensitivity, specificity, and diagnostic accuracy of the above diagnostic techniques against the Musculoskeletal Infection Society (MSIS) criteria and created receiver operating characteristics (ROC) curves to enable comparisons between each other. The quality of included papers was evaluated utilizing QUADAS-2 and QUADAS-C tools.

Results

Data from five comparative studies totaling 726 implants were pooled together. The diagnostic accuracy of DTT and sonication were 86.7% (95% CI 82.7 to 90.1) and 83.9% (95% CI 79.7 to 87.5), respectively. Pooled sensitivity and specificity showed no statistically significant differences between DTT and sonication (0.7 [95% CI 0.62 to 0.77] vs 0.72 [95% CI 0.65 to 0.78], p = 0.14; and 0.99 [95% CI 0.97 to 1] vs 0.97 [95% CI 0.93 to 0.99], p = 5.5, respectively).

Conclusions

This meta-analysis did not identify any clinically meaningful difference between the diagnostic potential of sonication and the chemical-based biofilm dislodgment methods. This finding remained robust after adjusting for the administration of antibiotics prophylaxis, implementation of the polymerase chain reaction of sonicated fluid, and study quality.

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Authors and Affiliations

  1. 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantinos Tsikopoulos & Paraskevi Papaioannidou

  2. Department of Genetics, Evolution and Environment, University College London, London, UK

    Savas Ilias Christofilos

  3. 1st Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitrios Kitridis & Panagiotis Givissis

  4. School of Medicine, University of Patras, Patras, Greece

    Konstantinos Sidiropoulos

  5. School of Medicine, Faculty of Health Sciences, University of Thessaly, Volos, Greece

    Panagiotis N. Stoikos

  6. Solid State Physics Sector, Physics Department, Faculty of Exact Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Christoforos Gravalidis

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  1. Konstantinos Tsikopoulos
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Contributions

Mr. Tsikopoulos conceptualized the idea before conducting this study, handled the statistical software, and drafted the original manuscript. Mr. Christofilos and Mr. Gravalidis contributed to the data extraction and drafting of this meta-analysis. Mr. Sidiropoulos contributed to the literature search and quality assessment. Mr. Kitridis assessed the methodological quality of the papers and contributed to the literature search. Mr. Stoikos contributed to the data extraction and editing of the article. Professor Givissis and Professor Papaioannidou supervised and reviewed the paper. All authors have read and agreed to the current version of the manuscript. Mr Christofilos participated in this study while he was an intern at Professor Maniatis’s group at the University College London.

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Correspondence to Konstantinos Tsikopoulos.

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The authors declare no competing interests.

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Prospective registration: We have registered this study to PROSPERO (CRD42021290099), and PRISMA 2020 guidelines have been followed [49].

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Tsikopoulos, K., Christofilos, S.I., Kitridis, D. et al. Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis. International Orthopaedics (SICOT) 46, 1215–1224 (2022). https://doi.org/10.1007/s00264-022-05350-z

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