Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection

Abstract

Background: A combination of laboratory, histopathological and microbiological tests for diagnosis of prosthetic joint infection (PJI) have been strongly recommended. This study aims to characterize the accuracy of individual or group tests, such as culture of sonicate fluid, synovial fluid and peri-implant tissue, C-reactive protein (CRP) and histopathology for detection of early, delayed and late PJI. Methods: A prospective study of patients undergoing hip or knee arthroplasty from February 2009 to February 2014 was performed in a Spanish tertiary health care hospital. The diagnostic accuracy of the different methods was evaluated constructing receiver-operating-characteristic (ROC) curve areas. Results: One hundred thirty consecutive patients were included: 18 (13.8%) early PJI, 35 (27%) delayed PJI and 77 (59.2%) late PJI. For individual parameters, the area under the ROC curve for peri-implant tissue culture was larger for early (0.917) than for delayed (0.829) and late PJI (0.778), p = 0.033. There was a significantly larger difference for ROC area in the synovial fluid culture for delayed (0.803) than for early (0.781) and late infections (0.679), p = 0.039. The comparison of the areas under the ROC curves for the two microbiological tests showed that sonicate fluid was significantly different from peri-implant tissue in delayed (0.951 vs 0.829, p = 0.005) and late PJI (0.901 vs 0.778, p = 0.000). The conjunction of preoperative parameters, synovial fluid culture and CRP, improved the accuracy for late PJI (p = 0.01). The conjunction of histopathology and sonicate fluid culture increased the area under ROC curve of sonication in early (0.917 vs 1.000); p = 0.06 and late cases (0.901 vs 0.999); p < 0.001. Conclusion: For early PJI, sonicate fluid and peri-implant tissue cultures achieve the same best sensitivity. For delayed and late PJI, sonicate fluid culture is the most sensitive individual diagnostic method. By combining histopathology and peri-implant tissue, all early, 97% of delayed and 94.8% of late cases are diagnosed. The conjunction of histopathology and sonicate fluid culture yields a sensitivity of 100% for all types of infection.

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

“…However, in a survey among European surgeons, many focused merely on synovial fluid culture, with one in four ignoring the diagnostic value of aspirate leukocyte count and polymorphonuclear cell (PMN) percentage [21]. However, synovial fluid culture has been found to have a relatively low sensitivity and specificity [30], and over reliance on identifying a micro-organism preoperatively in the synovial fluid can miss cases of PJI. In addition, knowing the causal micro-organism pre-operatively-or not-does not compromise reinfection rates after treatment [31].…”

Maltotriose-based probes for fluorescence and photoacoustic imaging of bacterial infections

“…Unfortunately, current PJI diagnostic tools necessitate sample collection from the prosthetic site and are divided into culture-based tools (ex. peri-implant tissue culture, synovial culture, and histology) 51 and culture-independent tools (ex. Ibis PLEX-ID technology 52 , MALDI-TOF mass spectroscopy 53 , nextgeneration sequencing 54 ).…”

Vancomycin prophylaxis in prosthetic joint surgery?

“…We can make a rough estimation on the number of PJIs that may be preventable when appropriate prophylaxis for S. epidermidis is given by using the PJI prevalence of 1% (low estimate), and that one third of new prosthetic joints infections will be of delayed type due to coagulase-negative staphylococci [8], and that appropriate surgical prophylaxis for joint arthroplasty reduces the risk for PJI for >80% [2]. In The Netherlands and Austria, 50 000 [9] and 35 000 [10] new prosthetic joints are implanted, respectively.…”