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Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection.

Publication ,  Journal Article
Kildow, BJ; Ryan, SP; Danilkowicz, R; Lazarides, AL; Vovos, TJ; Bolognesi, MP; Jiranek, WA; Seyler, TM
Published in: Orthopedics
November 1, 2020

The use of genetic sequencing modalities in the diagnosis of periprosthetic joint infection (PJI) and the identification of organisms has gained popularity recently. Polymerase chain reaction (PCR) offers timely results for common organisms. The purpose of this study was to compare the accuracy of broad-range PCR, conventional culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al in the diagnosis of PJI. In this retrospective study, aspirate or tissue samples were collected in 104 revision and 86 primary arthroplasties for routine diagnostic workup for PJI and sent to the laboratory for PCR. Concordance along with statistical differences between diagnostic studies were calculated using chi-square test for categorical data. On comparison with the MSIS criteria, concordance was significantly lower for PCR at 64.7% compared with 86.3% for culture (P<.001). There was no significant difference based on diagnosis of prior infection (P=.706) or sample collection method (tissue swab or synovial fluid) (P=.316). Of the 87 patients who met MSIS criteria, only 20 (23.0%) PCR samples had an organism identified. In this series, PCR had little utility as a stand-alone test for the diagnosis of PJI, with a sensitivity of only 23.0% when using MSIS criteria as the gold standard. Polymerase chain reaction also appears to be significantly less accurate than culture in the diagnosis of PJI. Currently, several laboratory tests used for either criteria for PJI diagnosis should be obtained along with the overall clinical picture to help guide decision-making for PJI treatment. [Orthopedics. 2020;43(6):333-338.].

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Published In

Orthopedics

DOI

EISSN

1938-2367

Publication Date

November 1, 2020

Volume

43

Issue

6

Start / End Page

333 / 338

Location

United States

Related Subject Headings

  • Synovial Fluid
  • Sensitivity and Specificity
  • Retrospective Studies
  • Prosthesis-Related Infections
  • Polymerase Chain Reaction
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Kildow, B. J., Ryan, S. P., Danilkowicz, R., Lazarides, A. L., Vovos, T. J., Bolognesi, M. P., … Seyler, T. M. (2020). Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection. Orthopedics, 43(6), 333–338. https://doi.org/10.3928/01477447-20200923-01
Kildow, Beau J., Sean P. Ryan, Richard Danilkowicz, Alexander L. Lazarides, Tyler J. Vovos, Michael P. Bolognesi, William A. Jiranek, and Thorsten M. Seyler. “Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection.Orthopedics 43, no. 6 (November 1, 2020): 333–38. https://doi.org/10.3928/01477447-20200923-01.
Kildow BJ, Ryan SP, Danilkowicz R, Lazarides AL, Vovos TJ, Bolognesi MP, et al. Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection. Orthopedics. 2020 Nov 1;43(6):333–8.
Kildow, Beau J., et al. “Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection.Orthopedics, vol. 43, no. 6, Nov. 2020, pp. 333–38. Pubmed, doi:10.3928/01477447-20200923-01.
Kildow BJ, Ryan SP, Danilkowicz R, Lazarides AL, Vovos TJ, Bolognesi MP, Jiranek WA, Seyler TM. Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection. Orthopedics. 2020 Nov 1;43(6):333–338.

Published In

Orthopedics

DOI

EISSN

1938-2367

Publication Date

November 1, 2020

Volume

43

Issue

6

Start / End Page

333 / 338

Location

United States

Related Subject Headings

  • Synovial Fluid
  • Sensitivity and Specificity
  • Retrospective Studies
  • Prosthesis-Related Infections
  • Polymerase Chain Reaction
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female