Diagnostic Methods for Prosthetic Joint Infection in Korea

Abstract

Prosthetic joint infection (PJI) poses a burden on patients and health care resources. PJI diagnosis can be challenging, owing to imperfect definition, alongside inadequate diagnostic techniques. In this review, we describe consensus definitions of PJI, approaches to diagnosis using methods available in Korea, and novel diagnostic methods.

Keywords: Diagnosis; Infection; Joint; Korea; Prosthetic.

Figure 1. Prosthesis sonication protocol used in the Mayo Clinic Clinical Microbiology Laboratory (Courtesy of David Lynch, reproduced with permission).

The implant is collected in a sterile container and 400 mL Ringer's solution is added followed by rigorous mixing (vortex). Vortex of the sample for 30 s before sonication increases the yield of positive cultures. Following vortex, the container was sonicated (40 kHz) in an ultrasound bath for 5 min. After sonication, sonicate fluid is vortexed for 30 s again, followed by centrifugation; for example, 50 mL aliquots are centrifuged at 3,150 g for 5 min, and the whole supernatant, but the bottom 0.5 mL, is discarded. As shown in Figure 1, after the concentration step, the supernatant is aspirated and 0.1 mL of the precipitate is plated onto aerobic and anaerobic sheep blood agar plates, which are incubated at 37°C in 5% CO₂ aerobically and anaerobically for 5 and 14 days, respectively.