Sonication in the diagnosis of periprosthetic infections. Significance and practical implementation

Endoprosthetic joint replacement is one of the most common and most successful operations in current medicine. With the increase in joint prosthesis implantations, the number of periprosthetic infections is also rising. Detection of the causative pathogen and its antimicrobial susceptibility is crucial for successful antibiotic therapy. For a reliable diagnosis, in addition to conventional microbiological methods (synovial fluid culture and intraoperative periprosthetic tissue samples), other methods of detecting biofilms are used. With sonication of the removed implant components, microorganisms are released from the implant surface and then detected qualitatively and quantitatively in the sonication fluid. The sonication is particularly useful for chronic, "low-grade" infections in which a small number of bacteria are present and the biofilm adheres more strongly to the prosthesis surface. The sonication fluid is suitable for aerobic and anaerobic cultures, in addition to newer, culture-independent detection methods (e.g., molecular methods, mass spectrometry, microcalorimetry). In the article the significance, advantages and disadvantages, and the practical implementation of the sonication of implants are presented and critically discussed.