# The application value and challenges of metagenomic next-generation sequencing in the diagnosis of periprosthetic joint infection after arthroplasty

## TL;DR

Metagenomic next-generation sequencing (mNGS) offers a fast and sensitive way to diagnose joint infections after surgery, but challenges like cost and standardization remain.

## Contribution

The paper reviews recent advances in mNGS for diagnosing periprosthetic joint infections and highlights its potential to improve patient outcomes.

## Key findings

- mNGS detects polymicrobial infections and rare pathogens that conventional methods miss.
- mNGS can predict antimicrobial resistance genes but needs validation against phenotypic resistance.
- mNGS helps reduce unnecessary surgeries and healthcare costs by enabling early targeted treatment.

## Abstract

Metagenomic next-generation sequencing (mNGS) demonstrates high sensitivity, rapid diagnostic capabilities, and the potential to identify complex pathogens in periprosthetic joint infection (PJI) following arthroplasty, particularly when conventional culture methods are limited. mNGS enables the detection of polymicrobial infections and rare/fastidious pathogens, along with the ability to predict antimicrobial resistance (AMR) genes; however, the concordance between genotypic predictions and phenotypic resistance profiles requires further validation. In clinical practice, mNGS overcomes biofilm-related diagnostic barriers, facilitating early targeted antibiotic therapy and potentially reducing unnecessary revision surgeries, thereby lowering overall healthcare costs and improving patient outcomes. Nevertheless, its widespread adoption is hindered by high costs, lack of standardization, and risks of false-positive/false-negative results. Future research priorities include optimizing sample processing protocols, host DNA depletion, establishing diagnostic thresholds, and validating mNGS through integration with conventional methods. This review synthesizes recent advances in the diagnostic accuracy and clinical utility of mNGS for PJI, aiming to provide evidence-based insights for therapeutic decision-making and enhance the prevention and management of PJI.