Alpha-Defensin Offers Limited Utility in Routine Workup of Periprosthetic Joint Infection

Kleeman-Forsthuber, Lindsay T.; Johnson, Roseann M.; Brady, Anna C.; Pollet, Aviva K.; Dennis, Douglas A.

doi:10.1016/j.arth.2020.12.018

Cited by 17 publications

(4 citation statements)

References 22 publications

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“…Additionally, 2 systematic reviews and meta-analyses found that the laboratory-based test and the point-of-care test had comparable accuracy for the diagnosis of PJI 70,74 . However, 3 recent studies have shown no additional benefit to the routine measurement of alpha-defensin as its diagnostic accuracy was comparable with those of other readily available synovial markers such as the WBC count and PMN% [75][76][77] . Furthermore, alpha-defensin has high false-positive rates in patients who develop metallosis following TJA.…”

Section: Alpha-defensinmentioning

confidence: 99%

Serum and Synovial Markers in the Diagnosis of Periprosthetic Joint Infection of the Hip, Knee, and Shoulder: An Algorithmic Approach

Tarabichi,

Goh,

Fraval

et al. 2024

Journal of Bone and Joint Surgery

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➤ No single test has demonstrated absolute accuracy for the diagnosis of periprosthetic joint infection (PJI).➤ Physicians rely on a combination of serological tests, synovial markers, and clinical findings plus clinical judgment to help to guide preoperative decision-making.➤ Several organizations have proposed criteria for the diagnosis of hip or knee PJI on which we now rely.➤ Given that shoulder arthroplasty has only recently become popular, it is possible that a shoulder-specific definition of PJI will be introduced in the coming years.➤ Although a number of serum and synovial markers have demonstrated high accuracy for the diagnosis of PJI of the hip and knee, further research is needed in order to identify markers that may be more suitable for the diagnosis of shoulder PJI and for the potential development and identification of specific serological tests as screening tools for PJI.

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Section: Alpha-defensinmentioning

confidence: 99%

Serum and Synovial Markers in the Diagnosis of Periprosthetic Joint Infection of the Hip, Knee, and Shoulder: An Algorithmic Approach

Tarabichi,

Goh,

Fraval

et al. 2024

Journal of Bone and Joint Surgery

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“…16 Synovial AD has initially been reported to have a high sensitivity and specificity > 95%, [17][18][19] but recent studies have shown lower diagnostic accuracy. [20][21][22][23][24] PMN are classically reported as a percentage of WBC in synovial fluid analysis, with optimal thresholds ranging from > 64% PMN to > 80% PMN. 11,14,15 In addition, there are ongoing efforts to improve the diagnosis of PJI.…”

Section: Introductionmentioning

confidence: 99%

Absolute synovial polymorphonuclear neutrophil cell count as a biomarker of periprosthetic joint infection

et al. 2023

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AimsThe aim of this study was to evaluate the diagnostic accuracy of the absolute synovial polymorphonuclear neutrophil cell (PMN) count for the diagnosis or exclusion of periprosthetic joint infection (PJI) after total hip (THA) or knee arthroplasty (TKA).MethodsIn this retrospective cohort study, 147 consecutive patients with acute or chronic complaints following THA and TKA were included. Diagnosis of PJI was established based on the 2018 International Consensus Meeting criteria. A total of 39 patients diagnosed with PJI (32 chronic and seven acute) and 108 patients with aseptic complications were surgically revised.ResultsUsing receiver operating characteristic curves and calculating the area under the curve (AUC), an optimal synovial cut-off value of 2,000 PMN/µl was determined (AUC 0.978 (95% confidence interval (CI) 0.946 to 1)). Using this cut-off, sensitivity and specificity of absolute synovial PMN count for PJI were 97.4% (95% CI 91.2 to 100) and 93.5% (95% CI 88.9 to 98.1), respectively. Positive and negative predictive value were 84.4% (95% CI 72.7 to 93.9) and 99.0% (95% CI 96.7 to 100), respectively. Exclusion of 20 patients with acute complications improved specificity to 97.9% (95% CI 94.6 to 100). Different cut-off values for THA (< 3,600 PMN/µl) and TKA (< 2,000 PMN/µl) were identified. Absolute synovial PMN count correlated strongly with synovial alpha-defensin (AD) (r = 0.759; p < 0.001). With a positive AD result, no additional PJI could be identified in any case.ConclusionAbsolute synovial PMN count is a widely available, rapid, cost-effective, and accurate marker in PJI diagnostics, whereas synovial AD appears to be a surrogate parameter of absolute synovial PMN count. Despite limitations in the early postoperative phase, wear, and rheumatic diseases in confirming PJI, an absolute synovial PMN count below 2,000/µl is highly suitable for ruling out PJI, with specific cut-off values for THA and TKA.Cite this article: Bone Joint J 2023;105-B(4):373–381.

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“…Alpha-defensin is such an example but has important limitations. It is not only too expensive to merit routine use (Kleeman-Forsthuber et al, 2021), but it has also been shown to have limited sensitivity if you use more sensitive definitions such as the EBJIS (Renz et al, 2018). We have previously shown that adding simple, inexpensive biomarkers that we can easily measure in our laboratory, such as synovial fluid C-reactive protein (CRP), adenosine deaminase (ADA), and alpha-2-macrogloblulin (A2M), does contribute to more accurate diagnosis (Sousa et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition

Diniz

Ribau

Vinha

et al. 2023

J. Bone Joint Infect.

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Abstract. Introduction: diagnosis of periprosthetic joint infection (PJI) is challenging, as no single test has absolute accuracy. The purpose of this study was to assess the utility of different simple synovial biomarkers in the diagnosis of PJI as defined by the European Bone and Joint Infection Society (EBJIS). Methods: we retrospectively identified all patients undergoing revision hip or knee arthroplasty from 2013 to 2019 on our prospectively maintained database. Only patients with minimum required infection diagnostic workup were included in the study. Patients with comorbidities that may influence the accuracy of synovial biomarkers were excluded. Receiver operator characteristic (ROC) curves were utilised to assess the diagnostic utility of synovial fluid white blood cell (WBC) count, polymorphonuclear leukocyte percentage (PMN %), C-reactive protein (CRP), adenosine deaminase (ADA), and alpha-2-microglobulin (A2M). Results: in total, 102 patients met the inclusion criteria. Of these, 58 were classified as infection unlikely, 8 as infection likely, and 36 as infection confirmed. Synovial WBC count (area under the curve (AUC) 0.94) demonstrated the best utility for the diagnosis of PJI, followed by PMN % (AUC 0.91), synovial CRP (AUC 0.90), ADA (AUC 0.82), and A2M (AUC 0.76). We found added value in the combined interpretation of different biomarkers. We calculated high sensitivity and negative predictive value if at least two of them are negative and high specificity and positive predictive value if at least two are elevated. Conclusion: current results show that synovial fluid investigation is a useful tool for the diagnosis of PJI, and the combined interpretation of simple and inexpensive biomarkers demonstrated improved diagnostic accuracy.

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Alpha-Defensin Offers Limited Utility in Routine Workup of Periprosthetic Joint Infection

Cited by 17 publications

References 22 publications

Serum and Synovial Markers in the Diagnosis of Periprosthetic Joint Infection of the Hip, Knee, and Shoulder: An Algorithmic Approach

Serum and Synovial Markers in the Diagnosis of Periprosthetic Joint Infection of the Hip, Knee, and Shoulder: An Algorithmic Approach

Absolute synovial polymorphonuclear neutrophil cell count as a biomarker of periprosthetic joint infection

Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition

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