Intraoperative Direct Sonication Improves the Time to Positivity of Culture in Patients Who Have Periprosthetic Joint Infection

Abstract

Background: Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty. Traditional sonication protocols typically involve specimen transport and laboratory-based processing. In this study, we implemented an intraoperative sonication technique performed directly in the operating room, enabling immediate transfer of samples into culture bottles. We evaluated its effectiveness in improving culture yield and reducing time to positivity (TTP). Methods: This retrospective cohort study included 190 patients (93 hips, 97 knees) who underwent revision surgery for PJI at a tertiary care center in China from August 2021 to January 2024. All patients met the 2018 International Consensus Meeting criteria for PJI. Intraoperative direct sonication was performed using a handheld ultrasonic cell disruptor on retrieved implants and soft tissues. The sonicated fluid was then cultured. Culture yield and TTP were compared between sonicated and nonsonicated samples. Results: Among the 190 patients, a total of 833 culture samples were collected from synovial fluids, tissues (presonication and postsonication), and prostheses (presonication and postsonication). Of these, 510 samples yielded positive cultures and were included in the analysis of TTP. Culture positivity rates were calculated by dividing the number of positive samples by the total number of samples per specimen type. Sonicated tissue (T-POS) and prosthesis (P-POS) samples had higher culture positivity rates than presonication samples. The T-POS samples had the highest culture yield (76.9%), while prosthesis presonication samples had the lowest (46.9%). Sonication significantly reduced TTP for both tissue and prosthesis samples (P < 0.05), with P-POS samples having the shortest median TTP (2.1 days). Conclusion: To our knowledge, this study is the first to demonstrate the effectiveness of in vivo intraoperative sonication in improving culture yield and reducing TTP in PJI patients. The method may support earlier transition to targeted antibiotics, potentially improving treatment outcomes and antibiotic stewardship. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.