Sonication for Enhanced Diagnosis of Prosthetic Joint Infection.

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Authors: Hartman CW, Kildow BJ, Antoniak D, Konigsberg BS, Garvin KL, Hewlett AL.
University of Nebraska Medical Center,Omaha, NE

Title: Sonication for Enhanced Diagnosis of Prosthetic Joint Infection.

Background: Culture negative prosthetic joint infections (PJI) present a therapeutic dilemma, and recent efforts have focused on improving the sensitivity of periprosthetic cultures.  Sonication has been shown to enhance the yield of standard clinical cultures in patients with prosthetic joint infection, but this has not been consistently validated.

Hypothesis/Purpose: Does the addition of sonication contribute to the yield of standard clinical cultures in patients with PJI?

Methods: A prospective study was performed on patients undergoing revision arthroplasty of the hip and knee.  The explanted prostheses were subjected to the sonication procedure in addition to routine cultures performed in the clinical microbiology laboratory. 

Results: A total of 201 patients undergoing revision or resection arthroplasty participated in the study.  Of these, 53 patients met MSIS Work Group criteria for PJI.  The sensitivity and specificity of standard cultures performed in the clinical microbiology laboratory were 77.4 and 93.2, respectively.  The sensitivity and specificity of sonicate fluid cultures were 77.4 and 90.5, respectively.    Three cases of PJI were detected by the sonicate fluid cultures but not by the clinical microbiology laboratory. 

Discussion: Our study did not demonstrate an improved sensitivity of sonication cultures compared to conventional periprosthetic tissue cultures.  Enhanced microbiologic techniques (utilization of pediatric blood culture bottles and prolonged incubation times) may contribute to the improved yield of cultures performed in the clinical microbiology laboratory.

Conclusion: Our data do not support the additional expense and effort needed to perform the sonication culture procedure.