Sonication of Removed Hip and Knee Prostheses for Diagnosis of Infection
Andrej Trampuz, M.D., Kerryl E. Piper, M.S., Melissa J. Jacobson, A.S., Arlen D. Hanssen, M.D., Krishnan K. Unni, M.D., Douglas R. Osmon, M.D., Jayawant N. Mandrekar, Ph.D., Franklin R. Cockerill, M.D., James M. Steckelberg, M.D., James F. Greenleaf, Ph.D., and Robin Patel, M.D.
Background Culturing of samples of periprosthetic tissue isthe standard method used for the microbiologic diagnosis ofprosthetic-joint infection, but this method is neither sensitivenor specific. In prosthetic-joint infection, microorganismsare typically present in a biofilm on the surface of the prosthesis.We hypothesized that culturing of samples obtained from theprosthesis would improve the microbiologic diagnosis of prosthetic-jointinfection.
Methods We performed a prospective trial comparing culture ofsamples obtained by sonication of explanted hip and knee prosthesesto dislodge adherent bacteria from the prosthesis with conventionalculture of periprosthetic tissue for the microbiologic diagnosisof prosthetic-joint infection among patients undergoing hipor knee revision or resection arthroplasty.
Results We studied 331 patients with total knee prostheses (207patients) or hip prostheses (124 patients); 252 patients hadaseptic failure, and 79 had prosthetic-joint infection. Withthe use of standardized nonmicrobiologic criteria to defineprosthetic-joint infection, the sensitivities of periprosthetic-tissueand sonicate-fluid cultures were 60.8% and 78.5% (P<0.001),respectively, and the specificities were 99.2% and 98.8%, respectively.Fourteen cases of prosthetic-joint infection were detected bysonicate-fluid culture but not by prosthetic-tissue culture.In patients receiving antimicrobial therapy within 14 days beforesurgery, the sensitivities of periprosthetic tissue and sonicate-fluidculture were 45.0% and 75.0% (P<0.001), respectively.
Conclusions In this study, culture of samples obtained by sonicationof prostheses was more sensitive than conventional periprosthetic-tissueculture for the microbiologic diagnosis of prosthetic hip andknee infection, especially in patients who had received antimicrobialtherapy within 14 days before surgery.
Source Information
From the Division of Infectious Diseases, Department of Internal Medicine (A.T., K.E.P., M.J.J., A.D.H., D.R.O., J.M.S., R.P.), the Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology (F.R.C., R.P.), the Department of Orthopedic Surgery (A.D.H., K.K.U.), the Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology (K.K.U.), the Division of Biostatistics (J.N.M.), and the Ultrasound Research Laboratory (J.F.G.), Mayo Clinic College of Medicine, Rochester, MN.
Address reprint requests to Dr. Patel at the Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First St. SW, Rochester, MN 55905, or at patel.robin{at}mayo.edu.
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