Description
Background: Diagnostics of possible infection in revision hip or knee arthroplasty, has so far essentially been by taking five tissue biopsies, as described by Kamme 1981. However, it is often experienced that tissue samples are without significant bacterial diagnostics, even though the surgeon's experience is that the field is infected. Based on knowledge of biomembrane formation, sonication has been developed as a method for diagnosing periprosthetic infection (PJI).Aim: To evaluate results with the first 49 cases using sonication, the sonication result was compared with the results of culture of tissue biopsies.
Materials and Methods: 49 implants removed during hip or knee revision of all courses from 2017 to 2023 were sent for sonication. According to EBJIS classification, preoperative 24 cases were with unlikely infection, 21 with infection likely and 4 with confirmed infection. If significant bacterial growth was found when culturing the sonication liquid, this was taken as diagnostic of bacterial infection. For all cases, five biopsies were taken a.m. Kamme. If two or more tissue biopsies showed growth of the same bacteria, this was taken as diagnostic for bacterial infection. Results after the two analysis methods were compared.
Results: In 28 operations, neither tissue biopsies nor sonication found diagnostic signs of bacteria. In 14 cases, sonication found bacteria, typically low virulence bacteria, with no growth in tissue samples. In 6 cases, both sonication and tissue samples found bacteria, and in all 6 cases, the same bacterial strain. In 1 operation, sonication found no growth, while tissue biopsies (3/5) found growth of Staphylococcus aureus
Interpretation / Conclusion: Sonication seems to have a role in bacterial diagnostic in revision surgery for PJI. Typically, low-virulence biomembrane forming bacteria such as e.g. Staph. Epidermidis is detected. In 14 cases (28%), bacteria could be detected by sonication, where tissue biopsies found no bacteria. In the cases where there was both growth by sonication and 2 of 5 possitve tissue cultures , there was good agreement in the bacterial diagnosis. However, in its current structure, the method is expensive and resource-demanding, which gives limitations to its use.
| Period | 2023 |
|---|---|
| Event title | Dansk Ortopædisk Selskab Kongres 2023 |
| Event type | Conference |