Advantages in orthopaedic implant infection diagnostics by additional analysis of explants.

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-05-01 Epub Date: 2025-02-19 DOI:10.1007/s00264-025-06424-4

Arnold J Suda, Thomas Miethke, Nadine Landua, Udo Obertacke

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引用次数: 0

Abstract

Purpose: Implant-associated infections are the most challenging complication in orthopaedics and trauma surgery as they often lead to long courses of illness and are a financial burden for the healthcare system. There is a need for fast, simple, and cheap identification of pathogens but the ideal detection method was not found yet. The work aims to test whether the detection of pathogens culturing the removed implant is more successful than from simultaneously taken tissue samples or punction fluid.

Methods: Implants were removed due to infection, irritation, or loosening. Tissue samples and joint fluids were processed for bacterial growth in sterile conditions. Samples were incubated and checked for growth. Bacterial identification and antibiotic sensitivity testing were performed. Data were anonymized, and statistical analysis was done using Excel and SAS, employing tests like Shapiro-Wilk, Mann-Whitney-U, and Kruskal-Wallis. Ethical approval was obtained for this study.

Results: Between February 2018 and April 2019, a total of 163 patients (175 cases) underwent orthopaedic implant removal for various reasons. 30 cases were not usable or analyzable due to missing or damaged reference material, so 145 cases could be evaluated due to study protocol. The range of detected bacteria was as expected and included low-virulent bacteria such as Micrococcus luteus and Corynebacteria. Pathogen detection by culture of the the explant´s was more sensitive (84.83%) than pathogen detection from tissue samples and punction fluid (64.14%, p<0.0001). Comorbidities did not play any role in the quality of detection but prior antibiotic treatment did influence the results of tissue diagnostics.

Conclusion: This study showed with a higher frequency of bacterial detection of orthopedic explant´s surface compared to tissue samples or punction fluid. This may reduce the number of samples and cost but enhances the quality of orthopaedic implant-related infection diagnostics.

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外植体附加分析在骨科植入物感染诊断中的优势。

目的：植入物相关感染是骨科和创伤手术中最具挑战性的并发症，因为它们通常导致长期病程，并且是医疗保健系统的经济负担。目前迫切需要快速、简便、廉价的病原菌鉴定方法，但尚未找到理想的检测方法。这项工作的目的是测试在移除的植入物中检测病原体是否比同时提取组织样本或穿刺液更成功。方法：种植体因感染、刺激或松动而取出。组织样本和关节液在无菌条件下进行细菌生长处理。将样品孵育并检查生长情况。进行细菌鉴定和药敏试验。数据匿名化，使用Excel和SAS进行统计分析，采用Shapiro-Wilk、Mann-Whitney-U和Kruskal-Wallis等测试。本研究已获得伦理批准。结果：2018年2月至2019年4月，共163例患者（175例）因各种原因行骨科种植体拔除术。30例由于缺少或损坏的参考材料而无法使用或分析，145例由于研究方案可以评估。检测到的细菌范围与预期一致，包括低毒力细菌，如黄体微球菌和棒状杆菌。植体培养对病原菌的检出率（84.83%）高于组织标本和穿刺液检出率（64.14%）。结论：骨科植体表面细菌检出率高于组织标本和穿刺液。这可能减少样本数量和成本，但提高了骨科植入物相关感染诊断的质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.