Sonication in shoulder surgery: is it necessary?
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ORIGINAL PAPER
Sonication in shoulder surgery: is it necessary? Carlos Torrens 1
&
Anna Fraile 1 & Fernando Santana 1 & Lluis Puig 1 & Albert Alier 1
Received: 26 January 2020 / Accepted: 18 March 2020 # SICOT aisbl 2020
Abstract Purpose The objective of the present study was to determine whether sonication yields greater sensitivity when compared with the traditional tissue culture in detecting peri-implant infections in shoulder surgery. Methods It is a retrospective study that includes 99 shoulder surgeries with implants explanted. The inclusion criteria required at least four tissue cultures, sonication of the material explanted, and a minimum follow-up of two years. Patients were classified according to the definition of periprosthetic shoulder infection of the 2018 International Consensus Meeting on Orthopedic Infections. The classifications are definitive infection, probable infection, possible infection, and unlikely infection. Results Among the 99 surgical procedures, 31 were considered definitive infections, 11 possible/probable infections, and 57 unlikely infections. Considering the cases with a definitive infection, the sensitivity of the tissue culture was 87.09% and the sensitivity of sonication stood at 80.64% (p = 0.406). Analyzing the cases with a definitive infection and those having a possible/ probable infection together and comparing them with those with unlikely infection, the sensitivity of sonication was 80.4% and the sensitivity of the tissue culture came to 91.4%. The specificity of the sonication was 98.1% and the specificity of the tissue culture was 99.6%. Conclusion The sensitivity of sonication in shoulder surgery (80.64%) is not superior to the sensitivity of the tissue culture (87.09%). Specificity remains high with both methods, being 98.1% in the sonication group and 99.6% in the tissue culture. Sonication brings no benefit to the detection of shoulder per-implant infections. Keywords Shoulder infection . Tissue culture . Sonication . Shoulder arthroplasty . Outcomes
Introduction The diagnosis of peri-implant infection in shoulder surgery remains a challenge. Firstly, the clinical signs and symptoms like fever, swelling, erythema, and drainage are not always present. Secondly, the usual pre-operative lab work (white blood cells count, erythrocyte sedimentation rate, and Creactive protein) does not rule out infection [1, 2]. Thirdly, the fact that low virulence germs (such as Cutibacterium acnes and Staphylococcus epidermidis) are commonly involved in peri-implant shoulder infections makes it even more difficult to arrive at a diagnosis of infection [3, 4].
* Carlos Torrens [email protected] 1
Department of Orthopedics, Hospital del Mar, Parc de Salut Mar, Passeig Marítim 25–29, 08003 Barcelona, Spain
Moreover, the number of culture negative periprosthetic joint infections in shoulder surgery has been reported to be higher than that reported with hip and knee surgery [5–7]. Sonication has been shown to be more sensitive than the traditional tissue culture in detecti
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