Rapi Jakub, Apostolopoulos Vasileios, Růžička Filip, Vaněrková Martina, Brančík Pavel, Tomáš Tomáš
First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno.
International Clinical Research Center, St. Anne's University Hospital, Brno.
Acta Chir Orthop Traumatol Cech. 2025 Aug;92(4):187-194. doi: 10.55095/achot2024/061.
The diagnosis of periprosthetic joint infection (PJI) can be particularly challenging in cases of low-grade chronic infection. The suspicion of infection is typically confirmed through cultures of synovial fluid and periprosthetic tissue. However, these methods may not always detect low-grade infections, which can lead to persistent infection and early failure of the prosthesis. The purpose of this study was to evaluate the effectiveness of sonication in enhancing the detection of PJI using polymerase chain reaction (PCR) analysis.
A prospective cohort of 26 patients, suspected of having mitigated PJI, underwent surgery at the First Department of Orthopaedic Surgery, St. Anne's University Hospital in Brno between 2019 and 2024. The cohort included 16 women and 10 men, aged 56 to 82 years, with infections involving hip (11 cases) or knee prostheses (15 cases). Standard PCR and sonication followed by PCR were used to confirm PJI.
In 20 out of 26 cases, both standard PCR and sonication-assisted PCR detected the infection(p= 0.014). However, in 6 cases, standard PCR failed to identify the pathogen, whereas sonication followed by PCR confirmed the infection. Among these, 4 cases had significantly positive results, and 2 showed weak positivity. The most common pathogens detected were coagulase-negative Staphylococcus (12 cases), followed by Staphylococcus aureus, Pseudomonas aeruginosa, and others.
The findings of this study indicate that the integration of sonication with PCR markedly enhances the detection of PJI, especially in instances where standard PCR techniques may be insufficient, such as in low-grade chronic infections.
在低度慢性感染病例中，人工关节周围感染（PJI）的诊断可能极具挑战性。感染的怀疑通常通过滑膜液和人工关节周围组织的培养来证实。然而，这些方法可能并不总能检测到低度感染，这可能导致感染持续存在和假体早期失效。本研究的目的是评估超声处理在使用聚合酶链反应（PCR）分析增强PJI检测方面的有效性。
2019年至2024年期间，26例疑似患有缓解期PJI的患者在布尔诺圣安妮大学医院第一骨科接受手术。该队列包括16名女性和10名男性，年龄在56至82岁之间，感染涉及髋关节假体（11例）或膝关节假体（15例）。采用标准PCR和超声处理后PCR来确诊PJI。
26例中有20例，标准PCR和超声辅助PCR均检测到感染（p = 0.014）。然而，有6例中，标准PCR未能识别病原体，而超声处理后PCR证实了感染。其中，4例结果显著为阳性，2例显示弱阳性。检测到的最常见病原体是凝固酶阴性葡萄球菌（12例），其次是金黄色葡萄球菌、铜绿假单胞菌等。
本研究结果表明，超声处理与PCR相结合显著增强了PJI的检测，特别是在标准PCR技术可能不足的情况下，如低度慢性感染。
