The application of sonication in diagnosis of periprosthetic joint infection.

Periprosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty. It has always been difficult to diagnose PJI, which is characterised by existence of biofilm around the implants. The application of sonication has proven advantageous for pathogen detection. This meta-analysis of clinical trials was performed to evaluate the diagnostic value of sonication and to compare it with traditional bacterial culture. We assessed 16 studies that evaluated sonication fluid cultures (SFC) for the diagnosis of PJI. It was shown that sonication may be of great value in PJI diagnosis, with a pooled sensitivity of 0.79 (95 % confidence interval [CI] = 0.76-0.81), specificity of 0.95 (CI = 0.94-0.96), DOR of 71.20 (CI = 31.08-163.10), PLR of 15.25 (CI = 6.44-36.15), and NLR of 0.23 (CI = 0.18-0.30). The AUC value of the SROC was 0.90. The results of this meta-analysis showed that culture of fluid after sonication was of great value for PJI diagnosis. Sonication was more sensitive than traditional tissue culture with lower specificity, especially for patients previously taking antibiotics.