Investigating the Microbiome of First Carpometacarpal Joint Arthritis by Next Generation Sequencing
Kyle J Plusch, B.A.1; Santiago Rengifo, MS2; Javad Parvizi, MD3; Asif M Ilyas, MD, MBA1; Emanuele Chisari, MD4
1Rothman Institute at Thomas Jefferson University, Philadelphia, PA; 2Rothman Orthopaedic Institute, Philadelphia, PA; 3Rothman Institute, Philadelphia, PA; 4Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Introduction: Recent research has demonstrated that inflammation plays a key role in the development of osteoarthritis (OA). There are indications that the microbial community of the joint may be a factor, but this is largely unknown. The purpose of this study is to investigate the natural microbiome of the 1st Carpometacarpal (CMC) joint in order to further elucidate the factors that lead to osteoarthritis.
Materials & Methods: We prospectively identified patients undergoing 1st CMC joint arthroplasty for primary osteoarthritis by two fellowship-trained orthopaedic hand surgeons at a single institution from April 2021 through April 2022. During each procedure, seven samples were collected for analysis by Next-Generation Sequencing (NGS): three negative controls (a skin swab over surgical site after betadine preparation, an air swab over the exposed CMC joint following surgical approach, and 5 mL sterile saline) and four intraoperative tissue samples (two synovial tissue samples, and two articular cartilage/bone samples from the excised trapezium). All samples were transported on the day of surgery in sterile containers to a certified provider of NGS services. Patient demographics were collected, as well as their history of corticosteroid injections in their 1st CMC joint prior to surgery.
Results: Samples were collected from 23 primary CMC arthroplasty procedures on 22 patients (one patient underwent staged bilateral surgery). Of the 22 patients, 18 (82%) had undergone 1 or more corticosteroid injections prior to surgery. A positive NGS result occurred in 12 out of 23 cases’ intraoperative samples. In one case, a negative control resulted in the same organism identified as the intraoperative sample; excluding this case leads to a final result of 11 out of 23 (47.8%) arthritic 1st CMC joints with organisms reported by NGS. A variety of organisms were reported, with the most common including C. Acnes (4), S. Epidermidis (2), and E. Cloacae (2). The complete list of organisms detected in each patient.
Conclusions: This study found that a nearly half of patients (47.8%) undergoing primary 1st CMC arthroplasty for osteoarthritis had microbial organisms within their CMC joint that were detectable by NGS. The types of organisms detected were highly variable. Further research is necessary to determine the specific role that this microbiome plays in the development of osteoarthritis.
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