Articles | Volume 11, issue 2
https://doi.org/10.5194/jbji-11-149-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-11-149-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
11 Mar 2026
Original full-length article |
| 11 Mar 2026
| 11 Mar 2026
Advancing diagnostics in suspected periprosthetic joint infections using synthetic synovial fluid and microcalorimetry
Amber De Bleeckere
Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium
Jeroen Neyt
Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
Jasper Van Heuverswyn
Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
Stien Vandendriessche
Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
Hannelore Hamerlinck
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
Annelynn Wallaert
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
Christophe Pattyn
Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
Bruno Verhasselt
Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
Jerina Boelens
Department of Medical Microbiology, Ghent University Hospital, Ghent, Belgium
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium
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Cited articles
Arciola, C. R., An, Y. H., Campoccia, D., Donati, M. E., and Montanaro, L.: Etiology of implant orthopedic infections: A survey on 1027 clinical isolates, Int. J. Artif. Organs, 28, 1091–1100, https://doi.org/10.1177/039139880502801106, 2005.
Barbero Allende, J. M., Gómez-Junyent, J., Sorlí Redó, L., Rodríguez-Pardo, D., Murillo Rubio, Ó., Fernández Sampedro, M., Escudero-Sánchez, R., García Gutiérrez, M., Portillo, M. E., Sancho, I., Rico Nieto, A., Guio Carrión, L., Soriano, A., and Morata Ruiz, L.: Description of reinfection of joint prosthesis after 2-stage replacement (infection of the 2nd stage prosthesis): A multicenter study, Enfermedades Infecc. y Microbiol. Clin. (English ed.), 42, 354–360, https://doi.org/10.1016/j.eimce.2023.07.002, 2024.
Baumbach, S. F., Prall, W. C., Scharpf, A. M., Hererich, V., Schmidt, M., Suedkamp, N. P., Stoehr, A., and Mayr, H. O.: Significant increase of pathogen detection rate by dry arthroscopic biopsies at suspected low-grade infection following total knee arthroplasty: a prospective observational study, Arch. Orthop. Trauma Surg., 138, 1583–1590, https://doi.org/10.1007/s00402-018-3032-8, 2018.
Berbari, E. F., Marculescu, C., Sia, I., Lahr, B. D., Hanssen, A. D., Steckelberg, J. M., Gullerud, R., and Osmon, D. R.: Culture-negative prosthetic joint infection, Clin. Infect. Dis., 45, 1113–1119, https://doi.org/10.1086/522184, 2007.
Bjarnsholt, T., Alhede, M., Alhede, M., Eickhardt-Sørensen, S. R., Moser, C., Kühl, M., Jensen, P. Ø., and Høiby, N.: The in vivo biofilm, Trends Microbiol., 21, 466–474, https://doi.org/10.1016/j.tim.2013.06.002, 2013.
Bjarnsholt, T., Whiteley, M., Rumbaugh, K. P., Stewart, P. S., Jensen, P., and Frimodt-Møller, N.: The importance of understanding the infectious microenvironment, Lancet Infect. Dis., 22, e88–e92, https://doi.org/10.1016/S1473-3099(21)00122-5, 2022.
De Bleeckere, A., van Charante, F., Debord, T., Vandendriessche, S., De Cock, M., Verstraete, M., Lamret, F., Lories, B., Boelens, J., Reffuveille, F., Steenackers, H. P., and Coenye, T.: A novel synthetic synovial fluid model for investigating biofilm formation and antibiotic susceptibility in prosthetic joint infections, Microbiol. Spectr., 13, https://doi.org/10.1128/spectrum.01980-24, 2025.
Bolger, A. M., Lohse, M., and Usadel, B.: Trimmomatic: A flexible trimmer for Illumina sequence data, Bioinformatics, 30, 2114–2120, https://doi.org/10.1093/bioinformatics/btu170, 2014.
Bonkat, G., Braissant, O., Widmer, A. F., Frei, R., Rieken, M., Wyler, S., Gasser, T. C., Wirz, D., Daniels, A. U., and Bachmann, A.: Rapid detection of urinary tract pathogens using microcalorimetry: Principle, technique and first results, BJU Int., 110, 892–897, https://doi.org/10.1111/j.1464-410X.2011.10902.x, 2012.
Bonkat, G., Braissant, O., Rieken, M., Solokhina, A., Widmer, A. F., Frei, R., van der Merwe, A., Wyler, S., Gasser, T. C., and Bachmann, A.: Standardization of isothermal microcalorimetry in urinary tract infection detection by using artificial urine, World J. Urol., 31, 553–557, https://doi.org/10.1007/s00345-012-0913-2, 2013.
Boyle, K. K., Wood, S., and Tarity, T. D.: Low-Virulence Organisms and Periprosthetic Joint Infection – Biofilm Considerations of These Organisms, Curr. Rev. Musculoskelet. Med., 11, 409–419, https://doi.org/10.1007/s12178-018-9503-2, 2018.
Braissant, O., Wirz, D., Göpfert, B., and Daniels, A. U.: Biomedical use of isothermal microcalorimeters, Sensors, 10, 9369–9383, https://doi.org/10.3390/s101009369, 2010.
Butler-Wu, S. M., Burns, E. M., Pottinger, P. S., Magaret, A. S., Rakeman, J. L., Matsen, F. A., and Cookson, B. T.: Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection, J. Clin. Microbiol., 49, 2490–2495, https://doi.org/10.1128/JCM.00450-11, 2011.
Cabello-Olmo, M., Oneca, M., Torre, P., Díaz, J. V., Encio, I. J., Barajas, M., and Araña, M.: Influence of storage temperature and packaging on bacteria and yeast viability in a plant-based fermented food, Foods, 9, https://doi.org/10.3390/foods9030302, 2020.
Christensen, M. H., Jakobsen, T. H., Lichtenberg, M., Hertz, F. B., Dahl, B., and Bjarnsholt, T.: Antimicrobial susceptibility testing of bone and joint pathogens using isothermal microcalorimetry, APMIS, https://doi.org/10.1111/apm.13470, 2024.
Cichos, K. H., Spitler, C. A., Quade, J. H., Johnson, J. P., Johnson, M. D., and Ghanem, E. S.: Isothermal Microcalorimetry Improves the Time to Diagnosis of Fracture-related Infection Compared with Conventional Tissue Cultures, Clin. Orthop. Relat. Res., 480, 1463–1473, https://doi.org/10.1097/CORR.0000000000002186, 2022.
Cichos, K. H., Ruark, R. J., and Ghanem, E. S.: Isothermal microcalorimetry improves accuracy and time to bacterial detection of periprosthetic joint infection after total joint arthroplasty, J. Clin. Microbiol., 61, https://doi.org/10.1128/jcm.00893-23, 2023.
Cornforth, D. M., Dees, J. L., Ibberson, C. B., Huse, H. K., Mathiesen, I. H., Kirketerp-Møller, K., Wolcott, R. D., Rumbaugh, K. P., Bjarnsholt, T., and Whiteley, M.: Pseudomonas aeruginosa transcriptome during human infection, Proc. Natl. Acad. Sci. USA, 115, e5125–e5134, https://doi.org/10.1073/pnas.1717525115, 2018.
Cuthbertson, L., Rogers, G. B., Walker, A. W., Oliver, A., Hoffman, L. R., Carroll, M. P., Parkhill, J., Bruce, K. D., and van der Gast, C. J.: Implications of multiple freeze-thwaing on respiratory samples for culture-independent analyses, J. Cyst. Fibros., 14, 464–467, https://doi.org/10.1016/j.jcf.2014.10.004, 2015.
Fernández-Rodríguez, D., Baker, C. M., Tarabichi, S., Johnson, E. E., Ciccotti, M. G., and Parvizi, J.: Mark Coventry Award: Human Knee Has a Distinct Microbiome: Implications for Periprosthetic Joint Infection, J. Arthroplasty, 38, S2–S6, https://doi.org/10.1016/j.arth.2023.03.084, 2023.
Flurin, L., Greenwood-Quaintance, K. E., and Patel, R.: Microbiology of polymicrobial prosthetic joint infection, Diagn. Microbiol. Infect. Dis., 94, 255–259, https://doi.org/10.1016/j.diagmicrobio.2019.01.006, 2019.
Fröschen, F. S., Randau, T. M., Franz, A., Molitor, E., and Hischebeth, G. T. R.: Microbiological Profiles of Patients with Periprosthetic Joint Infection of the Hip or Knee, Diagnostics, 12, https://doi.org/10.3390/diagnostics12071654, 2022.
Haraldsdóttir, I., Gunnlaugsdóttir, S. L., Kristjánsson, D. F., Erlendsdóttir, H., Helgason, K. O., Gudbrandsson, E. Þ., Sigurdardóttir, B., and Gottfredsson, M.: Changing Incidence, Aetiology and Outcomes of Prosthetic Joint Infections: A Population-Based Study in Iceland, J. Clin. Med., 14, 1–15, https://doi.org/10.3390/jcm14155289, 2025.
Jakobsen, T. H., Kirkegaard, J. B., Lichtenberg, M., Kvich, L. A., Gottlieb, H., McNally, M., and Bjarnsholt, T.: Detection limitations of bacteria in tissue samples, Bone Joint Res., 14, 560–567, https://doi.org/10.1302/2046-3758.146.bjr-2024-0410.r1, 2025.
Jeverica, S., El Sayed, F., Čamernik, P., Kocjančič, B., Sluga, B., Rottman, M., and Papst, L.: Growth detection of Cutibacterium acnes from orthopaedic implant-associated infections in anaerobic bottles from BACTEC and BacT/ALERT blood culture systems and comparison with conventional culture media, Anaerobe, 61, https://doi.org/10.1016/j.anaerobe.2019.102133, 2020.
Kandi, V., Palange, P., Vaish, R., Bhatti, A. B., Kale, V., Kandi, M. R., and Bhoomagiri, M. R.: Emerging Bacterial Infection: Identification and Clinical Significance of Kocuria Species, Cureus, 8, https://doi.org/10.7759/cureus.731, 2016.
Kato, H., Hagihara, M., Asai, N., Umemura, T., Hirai, J., Yamagishi, Y., Iwamoto, T., and Mikamo, H.: Comparison of microbial detection rates in microbial culture methods versus next-generation sequencing in patients with prosthetic joint infection: a systematic review and meta-analysis, J. Orthop. Surg. Res., 18, https://doi.org/10.1186/s13018-023-03973-5, 2023.
Koenemann, N. A., Sauerwald, F., Thimel, D., and Mayr, E.: A rare case of periprosthetic joint infection of the hip due to Kocuria spp., BMC Geriatr., 23, https://doi.org/10.1186/s12877-023-04286-2, 2023.
Li, H., Fu, J., Niu, E., Chai, W., Xu, C., Hao, L. B., and Chen, J.: The risk factors of polymicrobial periprosthetic joint infection: a single-center retrospective cohort study, BMC Musculoskelet. Disord., 22, https://doi.org/10.1186/s12891-021-04664-0, 2021.
Di Luca, M., Koliszak, A., Karbysheva, S., Chowdhary, A., Meis, J. F., and Trampuz, A.: Thermogenic characterization and antifungal susceptibility of candida auris by microcalorimetry, J. Fungi, 5, https://doi.org/10.3390/jof5040103, 2019.
McAleese, T., Ahmed, A., Berney, M., O'Riordan, R., and Cleary, M.: Kocuria rhizophila prosthetic hip joint infection, J. Surg. Case Reports, 8, https://doi.org/10.1093/jscr/rjad484, 2023.
McNally, M., Sousa, R., Wouthuyzen-Bakker, M., Chen, A. F., Soriano, A., Vogely, H. C., Clauss, M., Higuera, C. A., and Trebse, R.: The EBJIS definition of periprosthetic joint infection: A practical guide for clinicians, Bone Jt. J., 103, 18–25, https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1, 2021.
Morgenstern, C., Renz, N., Cabric, S., Maiolo, E., Perka, C., and Trampuz, A.: Thermogenic diagnosis of periprosthetic joint infection by microcalorimetry of synovial fluid, BMC Musculoskelet. Disord., 21, https://doi.org/10.1186/s12891-020-03366-3, 2020.
Nelson, C. L., McLaren, A. C., McLaren, S. G., Johnson, J. W., and Smeltzer, M. S.: Is aseptic loosening truly aseptic?, Clin. Orthop. Relat. Res., 437, 25–30, https://doi.org/10.1097/01.blo.0000175715.68624.3d, 2005.
Palan, J., Nolan, C., Sarantos, K., Westerman, R., King, R., and Foguet, P.: Culture-negative periprosthetic joint infections, EFORT Open Rev., 4, 585–594, https://doi.org/10.1302/2058-5241.4.180067, 2019.
Parvizi, J., Tan, T. L., Goswami, K., Higuera, C., Della Valle, C., Chen, A. F., and Shohat, N.: The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria, J. Arthroplasty, 33, 1309–1314, https://doi.org/10.1016/j.arth.2018.02.078, 2018.
Patel, R.: Periprosthetic Joint Infection, N. Engl. J. Med., 388, 251–262, https://doi.org/10.1056/NEJMra2203477, 2023.
Pattyn, C., De Bo, T., Anthonissen, J., Willekens, P., Claeys, G., and Audenaert, E. A.: Contamination risk of synovial biopsy cultures in total hip arthroplasty: A prospective review of 100 cases, HIP Int., 27, 595–598, https://doi.org/10.5301/hipint.5000508, 2017.
Pazos-Rojas, L. A., Cuellar-Sánchez, A., Romero-Cerón, A. L., Rivera-Urbalejo, A., Van Dillewijn, P., Luna-Vital, D. A., Muñoz-Rojas, J., Morales-García, Y. E., and Bustillos-Cristales, M. del R.: The Viable but Non-Culturable (VBNC) State, a Poorly Explored Aspect of Beneficial Bacteria, Microorganisms, 12, https://doi.org/10.3390/microorganisms12010039, 2024.
Pestrak, M. J., Gupta, T. T., Dusane, D. H., Guzior, D. V., Staats, A., Harro, J., Horswill, A. R., and Stoodley, P.: Investigation of synovial fluid induced Staphylococcus aureus aggregate development and its impact on surface attachment and biofilm formation, PLoS One, 15, https://doi.org/10.1371/journal.pone.0231791, 2020.
Premkumar, A., Kolin, D. A., Farley, K. X., Wilson, J. M., McLawhorn, A. S., Cross, M. B., and Sculco, P. K.: Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States, J. Arthroplasty, 36, 1484–1489.e3, https://doi.org/10.1016/j.arth.2020.12.005, 2021.
Prjibelski, A., Antipov, D., Meleshko, D., Lapidus, A., and Korobeynikov, A.: Using SPAdes De Novo Assembler, Curr. Protoc. Bioinforma., 70, 1–29, https://doi.org/10.1002/cpbi.102, 2020.
Ribeiro-Gonçalves, B., Francisco, A. P., Vaz, C., Ramirez, M., and Carriço, J. A.: PHYLOViZ Online: web-based tool for visualization, phylogenetic inference, analysis and sharing of minimum spanning trees, Nucleic Acids Res., 44, W246–W251, https://doi.org/10.1093/nar/gkw359, 2016.
Sanabria, A., Røkeberg, M. E. O., Johannessen, M., Sollid, J. E., Simonsen, G. S., and Hanssen, A. M.: Culturing periprosthetic tissue in BacT/Alert® Virtuo blood culture system leads to improved and faster detection of prosthetic joint infections, BMC Infect. Dis., 19, https://doi.org/10.1186/s12879-019-4206-x, 2019.
Shabana, N. S., Seeber, G., Soriano, A., Jutte, P. C., Westermann, S., Mithoe, G., Pirii, L., Siebers, T., Have, B. ten, Zijlstra, W., Lazovic, D., and Wouthuyzen-Bakker, M.: The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance, Antibiotics, 12, 10–17, https://doi.org/10.3390/antibiotics12010040, 2023.
Silva, M., Machado, M. P., Silva, D. N., Rossi, M., Moran-Gilad, J., Santos, S., Ramirez, M., and Carriço, J. A.: chewBBACA: A complete suite for gene-by-gene schema creation and strain identification, Microb. Genomics, 4, 1–7, https://doi.org/10.1099/mgen.0.000166, 2018.
Staats, A., Burback, P. W., Eltobgy, M., Parker, D. M., Amer, A. O., Wozniak, D. J., Wang, S.-H., Stevenson, K. B., Urish, K. L., and Stoodley, P.: Synovial Fluid-Induced Aggregation Occurs across Staphylococcus aureus Clinical Isolates and is Mechanistically Independent of Attached Biofilm Formation, Microbiol. Spectr., 9, https://doi.org/10.21037/aoj-20-85, 2021.
Staats, A., Burback, P. W., Schwieters, A., Li, D., Sullivan, A., Horswill, A. R., and Stoodley, P.: Rapid Aggregation of Staphylococcus aureus in Synovial Fluid Is Influenced by Synovial Fluid Concentration, Viscosity, and Fluid Dynamics, with Evidence of Polymer Bridging, MBio, 13, https://doi.org/10.1128/mbio.00236-22, 2022.
Vrancianu, C. O., Serban, B., Gheorghe-Barbu, I., Czobor Barbu, I., Cristian, R. E., Chifiriuc, M. C., and Cirstoiu, C.: The Challenge of Periprosthetic Joint Infection Diagnosis: From Current Methods to Emerging Biomarkers, Int. J. Mol. Sci., 24, https://doi.org/10.3390/ijms24054320, 2023.
Xu, Y., Maltesen, R. G., Larsen, L. H., Schønheyder, H. C., Le, V. Q., Nielsen, J. L., Nielsen, P. H., Thomsen, T. R., and Nielsen, K. L.: In vivo gene expression in a Staphylococcus aureus prosthetic joint infection characterized by RNA sequencing and metabolomics: A pilot study, BMC Microbiol., 16, 1–12, https://doi.org/10.1186/s12866-016-0695-6, 2016.
Short summary
Timely and accurate pathogen identification is essential for managing periprosthetic joint infections (PJIs), yet conventional culturing often yields false negatives and requires prolonged incubation. We evaluated an in-vivo-like synovial fluid medium and isothermal microcalorimetry. The combined use of these approaches improved detection rates and reduced time to diagnosis, offering valuable insights to advance PJI diagnostics and support better clinical decision-making.
Timely and accurate pathogen identification is essential for managing periprosthetic joint...
