title: Low sensitivity of implant sonication when screening for infection in revision surgery.
abstract: Background and purpose - Prosthetic-joint infection (PJI) is the most serious complication of arthroplasty, and accurate identification of a potentially responsible microorganism is essential for successful antibiotic treatment. We therefore determined the diagnostic accuracy of sonication and compared it with tissue culture as a screening tool in detecting prosthetic joint infection in revision arthroplasty. Patients and methods - 252 consecutive revision arthroplasty cases were enrolled. These cases were determined as being suspected or unsuspected of having infection according to standard criteria. Perioperatively, 6 periprosthetic interface tissue biopsies were obtained from each patient and the implants removed were sonicated. The sensitivity and specificity of periprosthetic tissue culture and sonication fluid cultures were determined. Results - Preoperatively, 75 revision cases were classified as having PJI (33 early and 42 late) and 177 were unsuspected of having infection. Compared with tissue culture, the sensitivity of the sonication fluid analysis was low: 0.47 (95% CI: 0.35-0.59) for sonication as compared to 0.68 (95% CI: 0.56-0.78) for tissue culture. The specificity of the sonication fluid analysis was higher than that for tissue culture: 0.99 (95% CI: 0.96-1.0) as compared to 0.80 (95% CI: 0.74-0.86). Interpretation - Sonication is a highly specific test for diagnosis of PJI. However, due to the low sensitivity, a negative sonication result does not rule out the presence of PJI. Thus, sonication is not of value for screening of microorganisms during revision surgery.
authors.affiliation: a Department of Orthopaedic Surgery , Prosthetic Joint Infection Unit , Sint Maartenskliniek.
authors.forename: Floor M
authors.initials: FM
authors.lastname: Van Diek
authors.affiliation: a Department of Orthopaedic Surgery , Prosthetic Joint Infection Unit , Sint Maartenskliniek.
authors.forename: Christiaan G M
authors.initials: CGM
authors.lastname: Albers
authors.affiliation: b Department of Scientific Research , Sint Maartenskliniek.
authors.forename: Miranda L
authors.initials: ML
authors.lastname: Van Hooff
authors.affiliation: c Department of Medical Microbiology and Infectious Diseases , Canisius-Wilhelmina Ziekenhuis.|d Department of Medical Microbiology , Radboudumc , Nijmegen , the Netherlands.
authors.forename: Jacques F
authors.initials: JF
authors.lastname: Meis
authors.affiliation: a Department of Orthopaedic Surgery , Prosthetic Joint Infection Unit , Sint Maartenskliniek.
authors.forename: Jon H M
authors.initials: JHM
authors.lastname: Goosen
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D001424:Bacterial Infections / Q000175:diagnosis; D001431:Bacteriological Techniques / Q000379:methods; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D007720:Knee Prosthesis / Q000009:adverse effects; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011237:Predictive Value of Tests; D011475:Prosthesis Failure / Q000209:etiology; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012086:Reoperation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013010:Sonication / Q000379:methods*