PCR-Based Diagnosis of Prosthetic Joint Infection

Abstract

bWe performed a meta-analysis to evaluate use of PCR assays for diagnosis of prosthetic joint infection (PJI). The pooled sensitivity and specificity were 0.86 (95% confidence interval [CI], 0.77 to 0.92) and 0.91 (CI, 0.81 to 0.96), respectively. Subgroup analyses showed that use of tissue samples may improve sensitivity, and quantitative PCR and sonication of prostheses fluid may improve specificity. The results showed that PCR is reliable and accurate for detection of PJI.P rosthetic joint infection (PJI) is one of the most common complications of total joint arthroplasty, with an incidence of 1 to 12%, and it always has catastrophic consequences (1, 2). The distinction between PJI and other causes of joint failure, such as aseptic loosening, is frequently difficult and still challenging. Several studies have assessed the diagnostic value of PCR techniques for diagnosing PJI. However, the true diagnostic capabilities of PCR assays remain controversial. Therefore, the aim of our study was to perform a meta-analysis to evaluate the detection validity of PCR in the diagnosis of PJI.We searched MEDLINE, EMBASE, and OVID for articles that were published between January 1990 and February 2013, using the following medical subject headings (MeSH) or free text words: (i) joint prosthesis, prosthesis infection, septic loosening, aseptic loosening, replacement, or arthroplasty and (ii) PCR. We also manually searched the reference lists of eligible studies and review articles. Our reviewers independently evaluated the selected studies using the following inclusion criteria: (i) the study reported the accuracy of PCR for the diagnosis of joint infection in comparison with visible purulence of joint aspirate or surgical site, presence of a sinus tract (fistula) communicating with the prosthesis, acute inflammation in histopathology sections of periprosthetic tissue, or simultaneously obtained microbiologic cultures from at least two periprosthetic tissue samples (the reference standard); (ii) sufficient data were reported to allow us to calculate the truepositive (TP), false-negative (FN), false-positive (FP), and truenegative (TN) values; (iii) the study reported evaluations of at least 10 patients, from which data could be extracted using our standardized data collection form (X. Qu and Z. Zhai). Discrepancies were resolved by discussion with other investigators and by consulting the original articles (Huiwu Li and K. Dai). We estimated the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) of summary receiver operating characteristic (ROC) curves to evaluate the capability of PCR assays for diagnosing PJI. We performed meta-regression and subgroup analyses to assess potential heterogeneity, and we constructed Deeks' funnel plot asymmetry test to evaluate potential publication bias. All of the statistical analyses were undertaken using STATA version 11 (StataCorp, College Station, TX).Our research yielded 2,024 primary st...

Meta-Analysis of Sonication Fluid Samples from Prosthetic Components for Diagnosis of Infection after Total Joint Arthroplasty

“…PCR techniques have demonstrated beneficial diagnostic value for diagnosing PJI; compared to intraoperative tissue culture, they theoretically have higher sensitivities and shorter turnaround times and are not as affected by treatment (6,10,14,15,21,35). However, differences in sample types analyzed by PCR may influence the diagnostic accuracy.…”

“…However, differences in sample types analyzed by PCR may influence the diagnostic accuracy. Sonication prosthetic fluid samples may offer additional insight for improving the diagnostic accuracy of PCRs (6,10,14,15,21,35). We previously performed a metaanalysis to evaluate PCR assays for diagnosing PJI (6).…”

Limitations of Gram staining for the diagnosis of infections following total hip or knee arthroplasty

“…The protocol used in the present meta-analysis was conducted as described in our previous studies (6,7,29) and based on recommendations in the methodological guidelines for conducting systematic reviews studying diagnostic accuracy (30) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (31).…”

“…Although various techniques can be used for the diagnosis of PJI, including preoperative laboratory tests, radiological examination, nuclear medicine detection, intraoperative culture and histopathology (5)(6)(7)(8), no gold-standard test for the diagnosis of PJI has been established, and the limited sensitivity and specificity of the tests that are available make the differentiation between PJI and other causes of prosthetic failure, such as metal allergy or aseptic loosening, challenging (2,9). PJI continues to cause difficulties for orthopedic surgeons, particularly when the clinical signs and regular serum inflammatory markers are not fully indicative of infection (10).…”

“…GS is also commonly used in the diagnosis of PJI, particularly in developing countries, as a result of its low cost, rapid turnaround time and ease of use; however, its value remains controversial due to conflicting results on the effectiveness of GS in the diagnosis of PJI (5,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The present meta-analysis was therefore performed as one of a series of meta-analyses (6,7,29) in order to evaluate the detection validity of GS for the diagnosis of PJI and to provide evidence-based advice to clinicians.…”