The Role of Implant Sonication in the Diagnosis of Periprosthetic Shoulder Infection

Background: The aim of this study was to investigate the validity of implant sonication fluid cultures in the diagnosis of shoulder periprosthetic joint infection (PJI) compared with tissue culture.

Methods: This was a retrospective case-control study analyzing all patients who underwent a revision surgery for any kind of suspected septic or aseptic event due to failed shoulder arthroplasty at our institution between July 2014 and December 2018. The diagnostic validity of implant sonication was analyzed on the basis of the last proposed definition criteria of the International Consensus Meeting and compared with standard tissue cultures.

Results: Of the 72 patients, a total of 28 (38.9%) were classified as infected. Of the 28 infected patients, 20 (71.4%) had an identified organism by tissue cultures, and Cutibacterium acnes was the most commonly isolated pathogen. The sensitivities of sonicate fluid (≥50 CFU/mL) and periprosthetic tissue culture for the diagnosis of periprosthetic shoulder infection were 36% and 61% (P = .016), and the specificities were 97.7% and 100% (P > .99), respectively. If no cutoff value was used in sonication culture, the sensitivity increased to 75% whereas the specificity dropped to 82%. Although there was no significant difference in sensitivity between tissue culture and the no-cutoff sonication fluid culture (61% vs. 75%, P = .125), the specificity of tissue culture was significantly higher (100% vs. 82%, P = .01).

Conclusion: Tissue culture showed a higher sensitivity and specificity than implant sonication in the diagnosis of shoulder PJI and should remain the gold standard for microbiological diagnosis of shoulder PJI.