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24.02.2022 | Review

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

verfasst von: Konstantinos Tsikopoulos, Savas Ilias Christofilos, Dimitrios Kitridis, Konstantinos Sidiropoulos, Panagiotis N. Stoikos, Christoforos Gravalidis, Panagiotis Givissis, Paraskevi Papaioannidou

Erschienen in: International Orthopaedics | Ausgabe 6/2022

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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.

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Titel: Is sonication superior to dithiothreitol in diagnosis of periprosthetic joint infections? A meta-analysis
verfasst von: Konstantinos Tsikopoulos
Savas Ilias Christofilos
Dimitrios Kitridis
Konstantinos Sidiropoulos
Panagiotis N. Stoikos
Christoforos Gravalidis
Panagiotis Givissis
Paraskevi Papaioannidou
Publikationsdatum: 24.02.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 6/2022
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-022-05350-z

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