Abstract
Purpose
The aim of this prospective study was to evaluate the diagnostic efficacy of sonicate fluid cultures (SFC) and the histological analysis of the periprosthetic membrane (PM) for the detection of periprosthetic joint infection (PJI).
Methods
The histological samples were evaluated according to the consensus classification of PM as defined by Morawietz and Krenn. All explanted endoprosthesis were subject to sonication. Additionally, a synovial aspiration and microbiological culture of tissue samples were performed for each patient. Twenty three of the 59 patients had an established PJI.
Results
Sonication achieved the highest sensitivity out of all diagnostic methods with 91 % and a specificity of 81 %. The PM achieved a sensitivity of 87 % and a specificity of 100 %. In three cases of PJI a pathogen was isolated solely by sonication while all other microbiological methods were negative. In seven cases there was a positive bacterial culture through sonication with negative histology.
Conclusions
Our results show a high correlation between the microbiological and histological results. In our patient group sonication achieved the highest sensitivity out of all diagnostic methods and was more sensitive than conventional microbiological methods.
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References
Achermann Y, Vogt M, Leunig M, Wüst J, Trampuz A (2010) Improved diagnosis of periprosthetic joint infection by multiplex polymerase chain reaction in sonication fluid of removed implants. J Clin Microbiol 48:1208–1214. doi:10.1128/jcm.00006-10
Barrack RL, Aggarwal A, Burnett RS, Clohisy JC, Ghanem E, Sharkey P, Parvizi J (2007) The fate of the unexpected positive intraoperative cultures after revision total knee arthroplasty. J Arthroplasty 22:94–99. doi:10.1016/j.arth.2007.03.029
Fink B, Makowiak C, Fuerst M, Berger I, Schäfer P, Frommelt L (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 90:874–878. doi:10.1302/0301-620x.90b7.20417
Frommelt L (2008) Aspiration of joint fluid for detection of the pathogen in periprosthetic infection. Orthopade 37:1027–1034, quiz 1035–1036. doi:10.1007/s00132-008-1345
Morawietz L, Schröder JH, Dynybil C, Perka C, Skwara A, Neidel J, Gehrke T, Frommelt L, Hansen T, Otto M, Barden B, Aigner T, Stiehl P, Schubert T, Meyer-Scholten C, König A, Ströbel P, Rader CP, Kirschner S, Lintner F, Rüther W, Bos I, Hendrich C, Kriegsmann J, Krenn V (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 59:591–597. doi:10.1136/jcp.2005.027458
Müller M, Morawietz L, Hasart O, Strube P, Perka C, Tohtz S (2008) Diagnosis of periprosthetic infection following total hip arthroplasty—evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to reoperatively select patients with a high probability of joint infection. J Orthop Surg Res 3:31. doi:10.1186/1749-799x-3-31
Müller M, Morawietz L, Hasart O, Strube P, Perka C, Tohtz S (2009) Histopathologische Diagnose der periprothetischen Gelenkinfektion nach Hüftgelenkersatz. Orthopade 38:1087–1096. doi:10.1007/s00132-009-1471-1
Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47:1403–1409. doi:10.1086/592973
Tohtz S, Morawietz L, Winkler T, Perka C (2009) Validity of frozen sections for analysis of periprosthetic loosening membranes. Clin Orthop Relat Res 468:762–768. doi:10.1007/s11999-009-1102-5
Trampuz A, Piper KE, Hanssen AD, Osmon DR, Cockerill FR, Steckelberg JM, Patel R (2006) Sonication of explanted prosthetic components in bags for diagnosis of prosthetic joint infection is associated with risk of contamination. J Clin Microbiol 44:628–631. doi:10.1128/jcm.44.2.628-631.2006
Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663. doi:10.1056/NEJMoa061588
Tunney MM, Patrick S, Gorman SP, Nixon JR, Anderson N, Davis RI, Hanna D, Ramage G (1998) Improved detection of infection in hip replacements a currently underestimated problem. J Bone Joint Surg Br 80:568–572
Acknowledgments
The authors would like to thank Reinhold Schiller M.D. for his comprehensive microbiological support.
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The authors declare that they have no conflict of interest.
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V. Janz and G. I. Wassilew contributed equally to the manuscript.
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Janz, V., Wassilew, G.I., Hasart, O. et al. Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection. International Orthopaedics (SICOT) 37, 931–936 (2013). https://doi.org/10.1007/s00264-013-1853-1
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DOI: https://doi.org/10.1007/s00264-013-1853-1