Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be ne...

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Autores principales: Hischebeth, Gunnar T.R., Gravius, Sascha, Buhr, Johanna K., Molitor, Ernst, Wimmer, Matthias D., Hoerauf, Achim, Bekeredjian-Ding, Isabelle, Randau, Thomas M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MyJove Corporation 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755521/
https://www.ncbi.nlm.nih.gov/pubmed/29286460
http://dx.doi.org/10.3791/55147
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author Hischebeth, Gunnar T.R.
Gravius, Sascha
Buhr, Johanna K.
Molitor, Ernst
Wimmer, Matthias D.
Hoerauf, Achim
Bekeredjian-Ding, Isabelle
Randau, Thomas M.
author_facet Hischebeth, Gunnar T.R.
Gravius, Sascha
Buhr, Johanna K.
Molitor, Ernst
Wimmer, Matthias D.
Hoerauf, Achim
Bekeredjian-Ding, Isabelle
Randau, Thomas M.
author_sort Hischebeth, Gunnar T.R.
collection PubMed
description In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life. The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI. We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.
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spelling pubmed-57555212018-01-19 Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction Hischebeth, Gunnar T.R. Gravius, Sascha Buhr, Johanna K. Molitor, Ernst Wimmer, Matthias D. Hoerauf, Achim Bekeredjian-Ding, Isabelle Randau, Thomas M. J Vis Exp Medicine In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life. The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI. We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI. MyJove Corporation 2017-12-03 /pmc/articles/PMC5755521/ /pubmed/29286460 http://dx.doi.org/10.3791/55147 Text en Copyright © 2017, Journal of Visualized Experiments http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To view a copy of this license, visithttp://creativecommons.org/licenses/by-nc-nd/3.0/
spellingShingle Medicine
Hischebeth, Gunnar T.R.
Gravius, Sascha
Buhr, Johanna K.
Molitor, Ernst
Wimmer, Matthias D.
Hoerauf, Achim
Bekeredjian-Ding, Isabelle
Randau, Thomas M.
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
title Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
title_full Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
title_fullStr Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
title_full_unstemmed Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
title_short Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
title_sort novel diagnostics in revision arthroplasty: implant sonication and multiplex polymerase chain reaction
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755521/
https://www.ncbi.nlm.nih.gov/pubmed/29286460
http://dx.doi.org/10.3791/55147
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