CORRInsights®: Sonication of Arthroplasty Implants Improves Accuracy of Periprosthetic Joint Infection Cultures

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Excerpt

Prosthetic joint infection (PJI) after total joint replacement is a devastating complication that can result in serious morbidity and permanent functional impairment. PJI is generally classified as early postoperative, acute hematogenous, or chronic depending on the time interval between surgery and onset of symptoms [8]. Managing this complication requires the accurate identification of causative organisms [2], and while early postoperative and acute hematogenous infections are normally caused by aggressive, fast-growing bacterial species [8, 14], chronic infections are frequently caused by slow-growing, less-virulent bacteria that are more difficult to identify [13].
There are a number of established diagnostic options for detecting the causative organisms in PJI, but preoperative arthrocentesis and intraoperative tissue cultures are the mainstays of diagnosis [10]. In recent years, biofilm-dislodging technologies like sonication [12] or chemical dislodging using dithiothreitol [6] are gaining more-widespread use.
In their study, Rothenberg and colleagues examined the accuracy of sonication cultures during revision THA and TKA, and compared the results from preoperative arthrocentesis and intraoperative tissue cultures. The authors concluded that implant sonication cultures in arthroplasty revisions improves the detection of bacteria in both clinical and occult infections.
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