Sonication versus Tissue Sampling for Diagnosis of Prosthetic Joint and Other Orthopedic Device-Related Infections

Abstract

Background Current guidelines recommend collection of multiple tissue samples for diagnosis of prosthetic joint infections (PJI). Sonication of explanted devices has been proposed as a potentially simpler alternative, however reported microbiological yield varies. Methods We evaluated sonication for diagnosis of PJI and other orthopaedic device-related infections (DRI) at the Oxford Bone Infection Unit between October 2012 and August 2016. We compared the performance of paired tissue and sonication cultures against a ‘gold-standard' of published clinical and composite clinical and microbiological definitions of infection. Results We analysed explanted devices and a median of five tissue specimens from 505 procedures. Among clinically infected cases the sensitivity of tissue and sonication culture was 69% (95% confidence interval 63-75) and 57% (50-63), respectively (p Conclusions Tissue culture is more sensitive and may be more specific than sonication for diagnosis of orthopaedic DRI in our setting. Variable methodology and case mix may explain reported differences between centres in the relative yield of tissue and sonication culture. Culture yield was highest for both methods combined.