title: Implant sonication for the diagnosis of prosthetic elbow infection.
abstract: BACKGROUND
  Periprosthetic infection is a potentially devastating complication of elbow arthroplasty, associated with formation of microbial biofilm on the implant surface. The definitive microbiologic diagnosis of periprosthetic infection after elbow arthroplasty may be difficult to establish. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware (a biofilm-sampling strategy).
  
  
  METHODS
  Patients undergoing revision elbow arthroplasty at our institution between July 2007 and July 2010, from each of whom 2 or more periprosthetic tissue cultures and 1 implant sonicate culture were obtained, were studied. A standardized definition of orthopedic implant-associated infection was applied.
  
  
  RESULTS
  We identified 27 subjects with aseptic failure and 9 with prosthetic elbow infection. Rheumatoid arthritis was the most common underlying disorder. The Coonrad-Morrey prosthesis was the most common type of implant used. The sensitivities of implant sonicate and periprosthetic tissue culture were 89% and 55%, respectively (P = .18), and the specificities were 100% and 93%, respectively (P = .16). Coagulase-negative staphylococci (n = 7) and Staphylococcus aureus (n = 2) were isolated in cases of infection.
  
  
  CONCLUSIONS
  Culture of the implant by sonication is at least as sensitive as periprosthetic tissue culture to detect prosthetic elbow infection.
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Paschalis
authors.initials: P
authors.lastname: Vergidis
authors.forename: Kerryl E
authors.initials: KE
authors.lastname: Greenwood-Quaintance
authors.forename: Joaquin
authors.initials: J
authors.lastname: Sanchez-Sotelo
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Morrey
authors.forename: Scott P
authors.initials: SP
authors.lastname: Steinmann
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Karau
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Osmon
authors.forename: Jayawant N
authors.initials: JN
authors.lastname: Mandrekar
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000175:diagnosis*; D001178:Arthroplasty; D018441:Biofilms; D003937:Diagnosis, Differential; D004551:Elbow Joint; D058569:Elbow Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013010:Sonication / Q000379:methods*; D055815:Young Adult
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