Sonication And 16S RRNA Gene PCR For Diagnosis Of Prosthetic Joint Infection

Background Prosthetic joint infection(PJI) is one of the devastating complications following joint replacement surgery. Without proper diagnosis and treatment in the early stage, it will result in more pain and finical burden for the patients.Bacterial documentation remains to be the cornerstone of diagnosis.Partâ… Sonication for Diagnosis of Prosthetic Joint InfectionObjective Biofilm which is attached in the implants plays significant roles in the negative PJI. Meanwhile,it can increase the burden of the therapy.The sonication technique can detach the biofilm from the surface of implants.Besides, Sonication of explanted prosthetic material has proved more sensitive than conventional microbiological culture.The purpose of this study was to evaluate the diagnostic efficacy of sonication for PJI.Methods A total of 46 cases who had underwent revision arthroplasty for any reason were included. The extracted prostheses were vortexed and sonicated, and the sonicatefluid were then incubated. Meanwhile, the periprosthetic tissue and synovial fluid were cultured as well. We subsequently compared the sensibility and specificity of sonicatefluid and traditional culture.Results The sensibility of sonicatefluid(64.71%,95%CI: 0.46-0.80) is significantly higher than traditional culture(32.35%, 95%CI: 0.17-0.50, respectively, P<0.05).ConclusionsSonication significantly increases the isolation rate of bacteria in revision arthroplasty.Part II Universal 16 S r RNA Gene PCR and Sequencing for Diagnosis of Prosthetic Joint InfectionObjective PCR(Polymerase Chain Reaction)is a speedy and valid molecular diagnosis method. The16 S r RNA gene PCRcan amplify the product to detect a range of bacteria, as this target is universally present in bacteria.The aim of this study was to prospectively compare the utility of the16 S r RNA gene PCR with that of convetionall culture of intraoperative tissue and synovial fluid for the diagnosis of PJI.Methods The study enrolled 6 AF(aseptic failure) and 22 PJI, who had undergone revision arthroplasty. We evaluated 16 S r RNA gene PCR for the diagnosis of PJI from sonicate fluid assayed with the universal primers followed by sequencing of amplified product, then used the convetional and Real time PCR to detect the pathogene of the intraoperative tissue and synovial fluid. Periprosthetic tissue andsynovial fluid were also collected and cultured for subsequent comparison of sensitivity.Results There are no significant difference was observed between tissue and synovial fluid cultures,also,in the conventional PCR and Real time PCR. The sensibility of Real time PCR which is applide in the synovial is significantly higher than conventional PCR.Conclusions Universal 16 S r RNA Gene PCR and Sequencing can not improve the detection rate of the bacteria in the PJI.Meanwhile,it is necessary for further study of Real time PCR and conventional PCR.Part III The united technology betweem sonication and PCR for Diagnosis of Prosthetic Joint InfectionObjective Though the sonication can improve the dection rate of the PIJ.Also the PCR is a speedy and valid molecular diagnosis method. The united technolosy between sonication and PCR still could not get powerful evidence in the diagnosis of the PJI. The aim of this study was to evaluate the diagnostic efficacy of sonication and realtime PCR for PJI.Methods The study enrolled 29 patients who had undergone revision arthroplasty. The extracted prostheses were vortexed and sonicated, and a part of the sonication fluid was incubated in the appropriate media,others was used for the Real time PCR.Results There are no significant difference was observed between sonication and the united technology.While,the sensivity of the united technology is high than the tissue and synovial fluid culture.Conclusions The futher study should be taken in the united united technology betweem sonication and Real time PCR.