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J Bone Jt Infect. 2017 Nov 17;2(4):218-223. doi: 10.7150/jbji.23078. eCollection 2017.

Diagnosis Of Persistent Infection In Prosthetic Two-Stage Exchange: PCR analysis of Sonication fluid From Bone Cement Spacers.

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Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland.


Introduction: When treating periprosthetic joint infections with a two-stage procedure, antibiotic-impregnated spacers are used in the interval between removal of prosthesis and reimplantation. According to our experience, cultures of sonicated spacers are most often negative. The objective of our study was to investigate whether PCR analysis would improve the detection of bacteria in the spacer sonication fluid. Methods: A prospective monocentric study was performed from September 2014 to January 2016. Inclusion criteria were two-stage procedure for prosthetic infection and agreement of the patient to participate in the study. Beside tissues samples and sonication, broad range bacterial PCRs, specific S. aureus PCRs and Unyvero-multiplex PCRs were performed on the sonicated spacer fluid. Results: 30 patients were identified (15 hip, 14 knee and 1 ankle replacements). At reimplantation, cultures of tissue samples and spacer sonication fluid were all negative. Broad range PCRs were all negative. Specific S. aureus PCRs were positive in 5 cases. We had two persistent infections and four cases of infection recurrence were observed, with bacteria different than for the initial infection in three cases. Conclusion: The three different types of PCRs did not detect any bacteria in spacer sonication fluid that was culture-negative. In our study, PCR did not improve the bacterial detection and did not help to predict whether the patient will present a persistent or recurrent infection. Prosthetic 2-stage exchange with short interval and antibiotic-impregnated spacer is an efficient treatment to eradicate infection as both culture- and molecular-based methods were unable to detect bacteria in spacer sonication fluid after reimplantation.


Infection; Sonication; Spacer; Two-Stage Exchange

Conflict of interest statement

Competing Interests: Sandrine Mariaux and Ulrika Furustrand Tafin have no disclosures. Here are disclosures of Prof. Olivier Borens: paid presentations for Zimmer-Biomet, Medacta, Lima and Heraeus. Unpaid consultant for Medacta, Lima and Zimmer-Biomet. Research support from Matthys, Bonesupport and Lima. Part of orthopaedic publications board of Journal of Bone and Joint Infection. Board member of Swiss orthopaedics, former Board member of European Bone and Joint infection society, President of AOTrauma Switzerland, Trustee AOFoundation.

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