Patient-Related Factors Affecting the Sensitivity of Sonication of Removed Hip and Knee Implants Against Conventional Tissue Cultures for Diagnosis of Prosthetic Joint Infections

Abstract

Despite its decreasing incidence, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of sonication fluid of the explanted hardware and to investigate the role of patientrelated factors affecting the sensitivity of the sonication method. We investigated 70 patients undergoing revision hip or knee arthroplasty, at our institution. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip prostheses and 22 knee prostheses). The sensitivities of sonication fluid culture and conventional tissue cultures were 81.25% and 56.25%, respectively (p-value = 0.043). The sensitivity of the sonication method was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis (p-values < 0.05). The sonication method has a greater sensitivity than the conventional periprosthetic tissue cultures for the periprosthetic infections, especially in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis.

Reactive oxygen species, aging and articular cartilage homeostasis

“…For redox functions, •NO can react with the enzyme metal cofactors like iron, copper, and zinc to regulate enzyme activity. For example, •NO inhibits copper-containing cytochrome P-450 and iron-containing catalase disrupting the redox balance and causing an increase in O 2 • and H 2 O 2 production [60,61,[76][77][78]. It has also been established that by binding to a reactive cysteine thiol, •NO can form S-nitrosothiols, a type of post-translational oxidative modification.…”

“…In addition to the production of nitrotyrosine and the depletion of -SH groups, ONOOH oxidizes lipids, causes DNA strand breakage, and deamination of DNA bases. Sequestering •NO production through NOS inhibition and/or scavenging O 2 •, through many different therapeutic approaches including antioxidant supplements, drugs, dietary polyphenols, and herbal medicines, could inhibit the deleterious effects associated with RNS [76]. However, the role •NO plays in OA is a multi-faceted, complicated one warranting more examination and understanding.…”