Li Yicheng, Wang Fei, Wahafu Tuerhongjiang, Mu Wenbo, Ji Baochao, Aimaiti Abudousaimi, Guo Xiaobin, Tian Haoyang, Zhang Xiaogang, Cao Li
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China.
J Bone Joint Surg Am. 2025 May 13;107(13):1439-1449. doi: 10.2106/JBJS.24.00744.
Conventional sonication is a recommended method in the diagnosis of periprosthetic joint infection (PJI), but the accuracy of diagnosis is still not ideal. We have applied the use of a handheld ultrasonic device and the intraoperative direct sonication of prostheses and soft tissues retrieved during surgery to improve the efficacy of the microbiological diagnosis of PJI and the incubation time of pathogens.
This was a retrospective study of patients diagnosed with PJI or aseptic loosening who underwent revision, DAIR (debridement, antibiotics, and implant retention), or resection, and for whom either sonication method was used between July 2017 and June 2023. Starting in August 2021, the removed implants and adjacent soft tissue were directly sonicated in a small metal container, and then the sonication fluid was incubated in blood culture bottles in the operating room under laminar air flow. Conventional sonication was continued through July 2021, and included vortex mixing for 30 seconds, sonication for 5 minutes, and additional vortex mixing for 30 seconds, as described by Trampuz et al. in 2007. The sensitivity, specificity, and time to positivity (TTP) of pathogen cultures were compared between intraoperative direct sonication and conventional sonication.
Of the 415 included patients, 266 had PJI and 149 had aseptic loosening. Fluid from intraoperative direct sonication and conventional sonication showed sensitivities of 88% and 69% (p < 0.001) and specificities of 84% and 93% (p = 0.105), respectively. Higher sensitivity was obtained by intraoperative direct sonication of only soft tissue than by direct sonication of only the prosthesis (80% versus 75%). Culture results from intraoperative direct sonication of soft tissue and the prosthesis were inconsistent in 55 cases (soft tissue plus prosthesis: 28 cases, soft tissue only: 17 cases, and prosthesis only: 10 cases). Gram-positive organisms grew significantly faster following direct sonication (median TTP for soft-tissue, 2.12 days [interquartile range (IQR), 1.40 to 3.16 days], and median TTP for the prosthesis, 2.02 days [IQR, 1.08 to 3.04 days]) compared with conventional sonication (median TTP, 2.92 days [IQR, 1.83 to 3.96 days]) (p = 0.003 and p < 0.001, respectively).
Intraoperative direct sonication was more sensitive than conventional sonication for the microbiological diagnosis of PJI and slightly shortened the TTP of microorganisms.
Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.
传统超声处理是诊断人工关节周围感染（PJI）的推荐方法，但诊断准确性仍不理想。我们应用了手持超声设备，并在手术中对取出的假体和软组织进行直接超声处理，以提高PJI微生物诊断的效能及病原体的培养时间。
这是一项回顾性研究，纳入了诊断为PJI或无菌性松动并接受翻修、清创、抗生素应用及植入物保留（DAIR）或切除术的患者，他们于2017年7月至2023年6月期间采用了两种超声处理方法中的任一种。从2021年8月起，取出的植入物和相邻软组织在一个小金属容器中直接进行超声处理，然后将超声处理液在手术室层流空气下的血培养瓶中培养。2021年7月前继续采用传统超声处理，方法包括如Trampuz等人在2007年所述的涡旋混合30秒、超声处理5分钟以及额外涡旋混合30秒。比较了术中直接超声处理和传统超声处理在病原体培养的敏感性、特异性及阳性时间（TTP）。
在纳入的415例患者中，266例患有PJI，149例患有无菌性松动。术中直接超声处理和传统超声处理的液体显示敏感性分别为88%和69%（p < 0.001），特异性分别为84%和93%（p = 0.105）。仅对软组织进行术中直接超声处理比仅对假体进行直接超声处理获得更高的敏感性（80%对75%）。软组织和假体术中直接超声处理的培养结果在55例中不一致（软组织加假体：28例，仅软组织：17例，仅假体：10例）。与传统超声处理（中位TTP，2.92天[四分位间距（IQR），1.83至3.96天]）相比，直接超声处理后革兰氏阳性菌生长明显更快（软组织中位TTP，2.12天[IQR，1.40至3.16天]，假体中位TTP，2.02天[IQR，1.08至3.04天]）（分别为p = 0.003和p < 0.001）。
术中直接超声处理在PJI的微生物诊断方面比传统超声处理更敏感，并略微缩短了微生物的TTP。
诊断性III级。有关证据水平的完整描述，请参阅作者须知。
