Implant sonication for the diagnosis of prosthetic elbow infection

Paschalis Vergidis, Kerryl E. Greenwood-Quaintance, Joaquin Sanchez-Sotelo, Bernard F. Morrey, Scott P. Steinmann, Melissa J. Karau, Douglas R. Osmon, Jayawant Mandrekar, James M. Steckelberg, Robin Patel

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background: Periprosthetic infection is a potentially devastating complication of elbow arthroplasty, associated with formation of microbial biofilm on the implant surface. The definitive microbiologic diagnosis of periprosthetic infection after elbow arthroplasty may be difficult to establish. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware (a biofilm-sampling strategy). Materials and methods: Patients undergoing revision elbow arthroplasty at our institution between July 2007 and July 2010, from each of whom 2 or more periprosthetic tissue cultures and 1 implant sonicate culture were obtained, were studied. A standardized definition of orthopedic implant-associated infection was applied. Results: We identified 27 subjects with aseptic failure and 9 with prosthetic elbow infection. Rheumatoid arthritis was the most common underlying disorder. The Coonrad-Morrey prosthesis was the most common type of implant used. The sensitivities of implant sonicate and periprosthetic tissue culture were 89% and 55%, respectively (P = .18), and the specificities were 100% and 93%, respectively (P = .16). Coagulase-negative staphylococci (n = 7) and Staphylococcus aureus (n = 2) were isolated in cases of infection. Conclusion: Culture of the implant by sonication is at least as sensitive as periprosthetic tissue culture to detect prosthetic elbow infection.

Original languageEnglish (US)
Pages (from-to)1275-1281
Number of pages7
JournalJournal of Shoulder and Elbow Surgery
Volume20
Issue number8
DOIs
StatePublished - Dec 2011

Fingerprint

Sonication
Elbow
Infection
Arthroplasty
Biofilms
Coagulase
Baths
Staphylococcus
Prostheses and Implants
Orthopedics
Staphylococcus aureus
Rheumatoid Arthritis

Keywords

  • Biofilm
  • Diagnostic Study
  • Elbow prosthesis
  • Implant
  • Level I
  • Periprosthetic tissue
  • Prosthetic joint infection
  • Sonication

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Vergidis, P., Greenwood-Quaintance, K. E., Sanchez-Sotelo, J., Morrey, B. F., Steinmann, S. P., Karau, M. J., ... Patel, R. (2011). Implant sonication for the diagnosis of prosthetic elbow infection. Journal of Shoulder and Elbow Surgery, 20(8), 1275-1281. https://doi.org/10.1016/j.jse.2011.06.016

Implant sonication for the diagnosis of prosthetic elbow infection. / Vergidis, Paschalis; Greenwood-Quaintance, Kerryl E.; Sanchez-Sotelo, Joaquin; Morrey, Bernard F.; Steinmann, Scott P.; Karau, Melissa J.; Osmon, Douglas R.; Mandrekar, Jayawant; Steckelberg, James M.; Patel, Robin.

In: Journal of Shoulder and Elbow Surgery, Vol. 20, No. 8, 12.2011, p. 1275-1281.

Research output: Contribution to journalArticle

Vergidis, P, Greenwood-Quaintance, KE, Sanchez-Sotelo, J, Morrey, BF, Steinmann, SP, Karau, MJ, Osmon, DR, Mandrekar, J, Steckelberg, JM & Patel, R 2011, 'Implant sonication for the diagnosis of prosthetic elbow infection', Journal of Shoulder and Elbow Surgery, vol. 20, no. 8, pp. 1275-1281. https://doi.org/10.1016/j.jse.2011.06.016
Vergidis P, Greenwood-Quaintance KE, Sanchez-Sotelo J, Morrey BF, Steinmann SP, Karau MJ et al. Implant sonication for the diagnosis of prosthetic elbow infection. Journal of Shoulder and Elbow Surgery. 2011 Dec;20(8):1275-1281. https://doi.org/10.1016/j.jse.2011.06.016
Vergidis, Paschalis ; Greenwood-Quaintance, Kerryl E. ; Sanchez-Sotelo, Joaquin ; Morrey, Bernard F. ; Steinmann, Scott P. ; Karau, Melissa J. ; Osmon, Douglas R. ; Mandrekar, Jayawant ; Steckelberg, James M. ; Patel, Robin. / Implant sonication for the diagnosis of prosthetic elbow infection. In: Journal of Shoulder and Elbow Surgery. 2011 ; Vol. 20, No. 8. pp. 1275-1281.
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abstract = "Background: Periprosthetic infection is a potentially devastating complication of elbow arthroplasty, associated with formation of microbial biofilm on the implant surface. The definitive microbiologic diagnosis of periprosthetic infection after elbow arthroplasty may be difficult to establish. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware (a biofilm-sampling strategy). Materials and methods: Patients undergoing revision elbow arthroplasty at our institution between July 2007 and July 2010, from each of whom 2 or more periprosthetic tissue cultures and 1 implant sonicate culture were obtained, were studied. A standardized definition of orthopedic implant-associated infection was applied. Results: We identified 27 subjects with aseptic failure and 9 with prosthetic elbow infection. Rheumatoid arthritis was the most common underlying disorder. The Coonrad-Morrey prosthesis was the most common type of implant used. The sensitivities of implant sonicate and periprosthetic tissue culture were 89{\%} and 55{\%}, respectively (P = .18), and the specificities were 100{\%} and 93{\%}, respectively (P = .16). Coagulase-negative staphylococci (n = 7) and Staphylococcus aureus (n = 2) were isolated in cases of infection. Conclusion: Culture of the implant by sonication is at least as sensitive as periprosthetic tissue culture to detect prosthetic elbow infection.",
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AU - Karau, Melissa J.

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