Liu Xiao-Kai, Zhao Heng-Xin, Ding Lan-Feng, Wang Yuan-He, Tian Shao-Qi
Department of Orthopedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266071, Shandong, China.
J Orthop Surg Res. 2025 Aug 7;20(1):740. doi: 10.1186/s13018-025-06160-w.
The primary reasons for postoperative joint prosthesis revision after total knee arthroplasty (TKA) are periprosthetic aseptic prosthesis loosening and joint infection (PJI). The objective of this study is to analyze the predominant microbial species responsible for PJI while also discussing was related.
A retrospective analysis was conducted on patients who underwent TKA revision surgery for the treatment of PJI and aseptic loosening of joint prostheses at our institution. Patients with aseptic loosening of the prosthesis are group A (n = 68), and patients with PJI are group B (n = 72). The fluid obtained after ultrasonic treatment was then subjected to microbial culture. Droplet Digital PCR (ddPCR) analysis was employed for DNA detection.
In our study, we included a total of 140 patients divided into groups A (patients with aseptic loosening of the prosthesis) and B (patients with PJI). The microbial culture results showed that 30 patients (45.45%) had Staphylococcus aureus infections, and 24 patients (36.36%) had methicillin-resistant Staphylococcus aureus (MRSA) infections in group B. The DNA testing results revealed that 54.41% (n = 37) of Group A patients still had microbial infections, including both Gram-positive and Gram-negative species. Notably, these patients showed negative microbial cultures but positive DNA detection. Among them, 83.78% (n = 31) had Gram-negative infections, while 16.22% (n = 6) had Gram-positive infections. In Group B, 66 patients (91.67%) had predominantly Gram-positive infections.
This study innovatively employed ddPCR for DNA detection and microbiologic analysis in 140 patients undergoing revision total knee arthroplasty due to periprosthetic joint infection and aseptic loosening, showed that most patients with PJI mainly affected by infections caused by high-virulence Gram-positive microbe, especially Staphylococcus aureus and MRSA. On the other hand, patients with aseptic loosening of the prosthesis may be associated with a history of multiple low-virulence microbial infections, primarily involving Gram-negative bacteria.
全膝关节置换术（TKA）后关节假体翻修的主要原因是假体周围无菌性松动和关节感染（PJI）。本研究的目的是分析导致PJI的主要微生物种类，并讨论相关问题。
对在我院接受TKA翻修手术以治疗PJI和关节假体无菌性松动的患者进行回顾性分析。假体无菌性松动患者为A组（n = 68），PJI患者为B组（n = 72）。然后将超声处理后获得的液体进行微生物培养。采用液滴数字PCR（ddPCR）分析进行DNA检测。
在我们的研究中，共纳入140例患者，分为A组（假体无菌性松动患者）和B组（PJI患者）。微生物培养结果显示，B组中30例患者（45.45%）感染金黄色葡萄球菌，24例患者（36.36%）感染耐甲氧西林金黄色葡萄球菌（MRSA）。DNA检测结果显示，A组54.41%（n = 37）的患者仍有微生物感染，包括革兰氏阳性菌和革兰氏阴性菌。值得注意的是，这些患者微生物培养呈阴性，但DNA检测呈阳性。其中，83.78%（n = 31）为革兰氏阴性菌感染，16.22%（n = 6）为革兰氏阳性菌感染。B组中，66例患者（91.67%）主要为革兰氏阳性菌感染。
本研究创新性地将ddPCR用于140例因假体周围关节感染和无菌性松动而接受翻修全膝关节置换术患者的DNA检测和微生物学分析，结果显示，大多数PJI患者主要受高毒力革兰氏阳性微生物感染，尤其是金黄色葡萄球菌和MRSA。另一方面，假体无菌性松动患者可能与多种低毒力微生物感染史有关，主要涉及革兰氏阴性菌。
