Abstract
Background
Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures.
Questions/purposes
Our aims in this study were to determine (1) if sonication results were predictive of failure, including reinfection, at 2-year followup; and (2) whether sonication of antibiotic spacers at the time of reimplantation improves sensitivity of intraoperative cultures.
Methods
We prospectively followed 36 consecutive patients undergoing two-stage reimplantation for periprosthetic hip or knee infection. Minimum followup was 19 months (mean, 29.9 months; range, 19–38 months). Results of intraoperative cultures and sonicated antibiotic spacers were analyzed.
Results
Positive sonication results were predictive of failure as defined by reinfection at 2-year followup. Among the 18 patients who had positive sonication results, reinfection developed in nine patients (50%) compared with two of 18 patients (11%) with negative sonication results (odds ratio, 8.0; 95% CI, 1.2–69.0). Sonication of antibiotic spacers improved the sensitivity of intraoperative cultures from 36% to 82%.
Conclusions
Sonication of antibiotic spacers appears to be useful in predicting failure attributable to recurrent infection after two-stage reimplantation. For patients with positive sonication cultures during reimplantation, more aggressive antimicrobial treatment may be indicated after reimplantation.
Level of Evidence
Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Acknowledgments
We thank Kaan Irgit MD, Department of Orthopaedics, Geisinger Medical Center (now at Cankaya Hospital, Ankara, Turkey) who assisted with the initial data gathering; Kent Strohecker MS (Department of Orthopaedic Surgery, Geisinger Medical Center) for assistance in preparation of the institutional review board documents; and Annamarie Horan PhD (Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA) for review of statistical analysis.
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One of the authors (CLN) certifies that he has or may receive payments or benefits during the study period from Zimmer, Inc (Warsaw, IN, USA) for consulting activities in an amount of USD (USD 10,000–100,000).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at Geisinger Medical Center, Danville, PA, USA.
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Nelson, C.L., Jones, R.B., Wingert, N.C. et al. Sonication of Antibiotic Spacers Predicts Failure during Two-stage Revision for Prosthetic Knee and Hip Infections. Clin Orthop Relat Res 472, 2208–2214 (2014). https://doi.org/10.1007/s11999-014-3571-4
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DOI: https://doi.org/10.1007/s11999-014-3571-4