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Results of a monocentric field study: value of histology compared to sonication method and conventional tissue culture in the diagnosis of periprosthetic joint infection (PJI)

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Abstract

Background

To confirm the diagnosis of periprosthetic joint infection (PJI), the Infectious Diseases Society of America (IDSA) and the International Consensus Meeting (ICM) have defined criteria that include histology as a minor criterion and the sonication method only as an additional criterion. The aim of this monocentric, retrospective study was to investigate the value of histology and whether sonication leads to a more accurate diagnosis.

Materials and methods

All revision surgeries for knee and hip arthroplasty between 2017 and 2020 were included. With regard to microbiological diagnostic, conventional culture of periprosthetic biopsies and sonication of explant material were performed. In addition, histology and non-specific inflammatory markers (CRP, leukocytes) were recorded.

Results

A total of 78 patients with PJI and 62 aseptic controls were included. From both microbiological methods (conventional culture / sonication), Staphyloccus (S.) epidermidis and S. aureus were detected most frequently. However, compared to the conventional microbiology, a higher sensitivity was calculated for sonication, albeit with a lower specificity in relation to a PJI. In two logistic regression models for the significance of all diagnostic parameters in PJI, the AUC was 0.92 and 0.96 with histology in particular making the decisive contribution in both models (p < 0. 001, both models).

Conclusion

Since histology showed the highest accuracy in the current study, its importance in the PJI criteria should be reevaluated. Sonication shows a high sensitivity for germ detection with a lower specificity and should only be used in combination with the conventional culture for microbiolgical diagnostics.

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Data availability

No datasets were generated or analysed during the current study

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Authors and Affiliations

  1. Department of Trauma Surgery, Orthopaedics & Sports Medicine, Hospital of Brothers of Mercy, Regensburg, Germany

    Alexander Röhrl, Bernd Füchtmeier & Christian Wulbrand

  2. Biostatistics, Helmholtz Centre for Infection Research, Brunswick, Germany

    Frank Klawonn

  3. Institute for Information Engineering, Ostfalia University, Wolfenbüttel, Germany

    Frank Klawonn

  4. Institute of Clinical Microbiology and Infection Prevention, University Hospital, Regensburg, Germany

    Andre Gessner

  5. Private Histopathology Service, Regensburg, Germany

    Jozef Zustin

  6. Gerhard Domagk Institute of Pathology, University Medical Center, Münster, Germany

    Jozef Zustin

  7. Institute of Laboratory Medicine, Microbiology and Infection Prevention, Hospital of Brothers of Mercy, Prüfeninger Straße 86, 93049, Regensburg, Germany

    Andreas Ambrosch

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Contributions

A.R. and A.A. responsible for study design, wrote manuscript, prepared figures 1 and tables F.K. responsible for statistics, prepared figure 2, reviewed mansucript B.F. responsible for study design C.W. reviewed manuscript J.Z. responsible for histology, reviewed manuscript A.G. resposible for microbiological data

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Correspondence to Andreas Ambrosch.

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Röhrl, A., Klawonn, F., Füchtmeier, B. et al. Results of a monocentric field study: value of histology compared to sonication method and conventional tissue culture in the diagnosis of periprosthetic joint infection (PJI). Infection (2024). https://doi.org/10.1007/s15010-024-02278-x

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