Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections

Abstract

Background: Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures.

Questions/purposes: Our aims in this study were to determine (1) if sonication results were predictive of failure, including reinfection, at 2-year followup; and (2) whether sonication of antibiotic spacers at the time of reimplantation improves sensitivity of intraoperative cultures.

Methods: We prospectively followed 36 consecutive patients undergoing two-stage reimplantation for periprosthetic hip or knee infection. Minimum followup was 19 months (mean, 29.9 months; range, 19–38 months). Results of intraoperative cultures and sonicated antibiotic spacers were analyzed.

Results: Positive sonication results were predictive of failure as defined by reinfection at 2-year followup. Among the 18 patients who had positive sonication results, reinfection developed in nine patients (50%) compared with two of 18 patients (11%) with negative sonication results (odds ratio, 8.0; 95% CI, 1.2–69.0). Sonication of antibiotic spacers improved the sensitivity of intraoperative cultures from 45% to 82%. [corrected].

Conclusions: Sonication of antibiotic spacers appears to be useful in predicting failure attributable to recurrent infection after two-stage reimplantation. For patients with positive sonication cultures during reimplantation, more aggressive antimicrobial treatment may be indicated after reimplantation.

Level of evidence: Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

Figures

Fig. 1A–F

Preoperative (A) AP and (B) lateral radiographs show an infected TKA before prosthesis removal. (C) AP and (D) lateral radiographs show the knee of the same patient after removal of the prosthesis and placement of an antibiotic impregnated articulating spacer. (E) AP and (F) lateral radiographs after removal of the antibiotic spacer prosthesis and successful two-stage revision TKA with a stemmed revision knee implant are shown.