Evaluation of sonication for the detection of periprosthetic joint infection in hip revision arthroplasty: a retrospective observational single-center study of 288 episodes

TL;DR

This study evaluates if sonication improves the detection of hip joint infections during revision surgeries, finding it provides additional information in a small number of cases.

Contribution

The study provides empirical evidence on the added value of sonication in diagnosing hip periprosthetic joint infections.

Findings

Sonication fluid cultures provided additional clinical information in 15 out of 288 hip revision episodes.

Coagulase-negative staphylococci and Staphylococcus aureus were the most common bacteria detected.

Sonication improved microbiological yield in a small subset of cases across all infection likelihood groups.

Abstract

Sonication fluid cultures have been proposed as a complementary diagnostic method to intraoperative tissue culture sampling for the diagnosis of periprosthetic joint infection (PJI). We evaluated whether sonication provides additional clinically relevant information in the diagnosis of PJI in hip revision.

Episodes of hip revision performed between January 2007 and December 2016 were assigned retrospectively to the European Bone and Joint Infection Society (EBJIS) definition of periprosthetic joint infection: infection unlikely, infection likely, and infection confirmed. The inclusion criteria were a minimum of 2 perioperative tissue cultures collected at the index procedure and sonication performed on a removed implant. The results of the tissue cultures were compared with the results of the implant sonication fluid cultures (SFCs).

288 hip revision episodes in 250 patients fulfilled the inclusion criteria and were analyzed. The “infection unlikely” group included 203 episodes (178 patients), the “infection likely” group included 5 episodes (5 patients), and the “infection confirmed” group included 80 episodes (67 patients). SFC delivered additional clinical information in 15/288: 6 of 203 episodes in the “infection unlikely” group, 2 of 5 episodes in the “infection likely” group, and 7 of 80 in the “infection confirmed” group. Coagulase-negative staphylococci and Staphylococcus aureus were the dominant bacterial species in both the SFC and tissue cultures.

In addition to tissue cultures, sonication fluid cultures optimized the microbiological yield in 15 out of 288 hip revision episodes.

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