Microfluidic and lab-on-a-chip devices for detection and diagnosis of periprosthetic joint infections

Abstract

Periprosthetic joint infection (PJI) is a serious complication of prosthetic joint implantation, which poses a significant burden on both individuals and society. Effective treatment relies on the rapid identification of the underlying cause; however, the diagnosis of PJI remains challenging, inefficient, and time-consuming. Current detection protocols based on clinical signs and conventional cultures often fail to provide definitive results. Additionally, advanced molecular analyses of synovial fluid samples, while effective, require specialized personnel and are impractical for on-site applications. This review aims to highlight the potential of microfluidic and lab-on-a-chip technologies in enhancing the identification of PJI, offering a rapid and accurate diagnostic method.

Keywords: Biosensors; Microbial infections; Microfluidic devices; Total hip arthroplasty.

Fig. 1

Mosaic of representative images of microfluidic devices employed for bacterial detection. A) A schematic illustration of the entire experimental process performed on the integrated microfluidic chip for PJI analysis, comprising of bacteria isolation, cell lysis, DNA amplification and optical detection. Modified with permission from Chen et al. (2017). B) An illustration (a) and a photograph (b) of the microfluidic chip developed by Liu et al. (2019). It is comprised of several normally closed microvalves, micropumps, and a waste unit for fluid transportation. N: PCR reaction chamber for the negative control, P: PCR reaction chamber for the positive control, and S: PCR reaction chamber for the sample. C) Schematic of the Raman-optofluidic platform reported by Hunter et al. (2019) and detection performance of the optofluidic platform for monocultures of bacteria in fetal bovine serum. Modified with permission from (Hunter et al. 2019)

Fig. 2

Mosaic of representative images of microfluidic devices for biomarker detection. (A) The synovial chip, reported from Krebs et al., allows for the capture of white blood cells (WBC) subpopulations from synovial fluid samples in serially connected microchannel functionalized via specific antibodies binding. Cell capture specificity is evaluated by fluorescent labelling of isolated cells. Adapted with permission from Krebs et al. (2017). (B) A schematic and photograph of the microfluidic on-chip SELEX reported by Gandotra et al. The chip bears a automated microfluidic control system for automated SELEX, or selection of PJI biomarkers-specific aptamers. Modified with permission from Gandotra et al. (2022). (C) Specificity tests for the aptamer-ased ELISA-like assay for HPN-1, and IgG and (D) HPN-1 measurements from the aptamer-based ELISA-like assay while using clinical PJI samples. Adapted with permission from Gandotra et al. (2022)

Fig. 3

Comparative analysis of microfluidic diagnostic platforms developed for PJI detection