Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis

Konstantinos Tsikopoulos; Savas Ilias Christofilos; Dimitrios Kitridis; Konstantinos Sidiropoulos; Panagiotis N Stoikos; Christoforos Gravalidis; Panagiotis Givissis; Paraskevi Papaioannidou

doi:10.1007/s00264-022-05350-z

Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis

Int Orthop. 2022 Jun;46(6):1215-1224. doi: 10.1007/s00264-022-05350-z. Epub 2022 Feb 24.

Authors

Konstantinos Tsikopoulos¹, Savas Ilias Christofilos², Dimitrios Kitridis³, Konstantinos Sidiropoulos⁴, Panagiotis N Stoikos⁵, Christoforos Gravalidis⁶, Panagiotis Givissis³, Paraskevi Papaioannidou⁷

Affiliations

¹ 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece. ktsikopo@auth.gr.
² Department of Genetics, Evolution and Environment, University College London, London, UK.
³ 1st Orthopaedic Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁴ School of Medicine, University of Patras, Patras, Greece.
⁵ School of Medicine, Faculty of Health Sciences, University of Thessaly, Volos, Greece.
⁶ Solid State Physics Sector, Physics Department, Faculty of Exact Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁷ 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.

PMID: 35199219
DOI: 10.1007/s00264-022-05350-z

Abstract

Purpose: Even though effective techniques in diagnosis of periprosthetic joint infections (PJIs) have been developed, the optimal modality has yet to be determined. The present meta-analysis aimed to compare the diagnostic accuracy of dithiothreitol (DTT) and sonication against the Musculoskeletal Infection Society criteria in patients undergoing revision joint surgery.

Methods: We searched the PubMed, Scopus, and Central Cochrane register of controlled trials as well as gray literature until the 9th of November, 2021. We included articles considering the comparative diagnostic accuracy of sonication and DTT in adult patients having revision hip and knee arthroplasty for septic or aseptic reasons. We calculated pooled sensitivity, specificity, and diagnostic accuracy of the above diagnostic techniques against the Musculoskeletal Infection Society (MSIS) criteria and created receiver operating characteristics (ROC) curves to enable comparisons between each other. The quality of included papers was evaluated utilizing QUADAS-2 and QUADAS-C tools.

Results: Data from five comparative studies totaling 726 implants were pooled together. The diagnostic accuracy of DTT and sonication were 86.7% (95% CI 82.7 to 90.1) and 83.9% (95% CI 79.7 to 87.5), respectively. Pooled sensitivity and specificity showed no statistically significant differences between DTT and sonication (0.7 [95% CI 0.62 to 0.77] vs 0.72 [95% CI 0.65 to 0.78], p = 0.14; and 0.99 [95% CI 0.97 to 1] vs 0.97 [95% CI 0.93 to 0.99], p = 5.5, respectively).

Conclusions: This meta-analysis did not identify any clinically meaningful difference between the diagnostic potential of sonication and the chemical-based biofilm dislodgment methods. This finding remained robust after adjusting for the administration of antibiotics prophylaxis, implementation of the polymerase chain reaction of sonicated fluid, and study quality.

Keywords: DTT; Diagnostic accuracy; Dithiothreitol; Meta-analysis; Sensitivity; Sonication; Specificity.

Publication types

Meta-Analysis
Review

MeSH terms

Adult
Arthritis, Infectious* / diagnosis
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Dithiothreitol*
Hip Prosthesis / adverse effects
Humans
Knee Prosthesis / adverse effects
Prosthesis-Related Infections* / diagnosis
Sensitivity and Specificity
Sonication*

Substances

Dithiothreitol