Alpha-defensin does not provide additional benefit over leukocyte esterase in the diagnosis of periprosthetic joint infection

Shohat, Noam; Yacovelli, Steven; Chisari, Emanuele; Clarkson, Samuel; Mann, Derek A.; Parvızı, Javad

doi:10.1080/14737159.2021.1943364

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…22,24 Consistent with our findings, recent studies also failed to find any additional benefit of synovial AD over conventional synovial fluid analysis or leucocyte esterase. 13,24 However, Ivy et al 24 could include only 18 arthroplasties fulfilling the criteria of PJI, preventing subgroup analyses, and limiting overall transferability. Notably, the AUC for %PMN to diagnose PJI was even higher in our study compared to Ivy et al 24 (0.971 vs 0.886).…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Preoperative diagnostic accuracy is usually achieved by a combination of parameters, including serum CRP, D-dimer level, synovial white blood cell (WBC) count, and differential leucocyte esterase rapid test and microbiological analysis. [11][12][13] Corresponding synovial WBC count thresholds for PJI diagnosis may be useful for routine clinical practice, but suggestions regarding optimal accuracy range from > 1,100 to > 3,000 cells. 14,15 Another marker for PJI is synovial alpha-defensin (AD), a peptide released by polymorphonuclear neutrophils (PMN) as part of the host-defense innate immune system.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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“…They incorporated synovial alpha defensin as a significant minor criterion, which was given a score of 3 points, which was higher than the individual value given to any other minor criteria. Sensitivity and specificity were approximately 98% and over 99% respectively based on external validation, which was higher than previous scoring criteria [18,[25][26][27]. Later in 2018 and 2019, the definition was given another thorough review by the European Bone and Joint Infection Society (EBJIS) with support from the MSIS, European Society of Clinical Microbiology and Infectious Diseases (ESCMID).…”

Section: Diagnosis Of Periprosthetic Joint Infectionmentioning

confidence: 92%

“…They can be deemed indecipherable due to colorimetric nature of the strip pad, which simultaneously introduces human error, by way of subjectivity, into the equation as well [15][16][17]. In addition, there has been significant discussion concerning other reagents playing a role in the diagnosis of PJI, such as alpha defensin or D Dimer [11,18]. With the addition of leukocyte esterase, there was an increase in sensitivity of diagnosing PJI, with a small decrease from around 98% to 95% in specificity [17].…”

Section: Diagnosis Of Periprosthetic Joint Infectionmentioning

confidence: 99%

A review of current practices in periprosthetic joint infection debridement and revision arthroplasty

et al. 2022

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Background Periprosthetic joint infection remains a significant challenge for arthroplasty surgeons globally. Over the last few decades, there has been much advancement in terms of treatment and diagnosis, however, the fight rages on. As management of periprosthetic joint infections continues to evolve, it is critical to reflect back on current debridement practices to establish common ground as well as identify areas for future research and improvement. Body In order to understand the debridement techniques of periprosthetic joint infections, one must also understand how to diagnose a periprosthetic joint infection. Multiple definitions have been elucidated over the years with no single consensus established but rather sets of criteria. Once a diagnosis has been established the decision of debridement method becomes whether to proceed with single vs two-stage revision based on the probability of infection as well as individual patient factors. After much study, two-stage revision has emerged as the gold standard in the management of periprosthetic infections but single-stage remains prominent with further and further research. Conclusion Despite decades of data, there is no single treatment algorithm for periprosthetic joint infections and subsequent debridement technique. Our review touches on the goals of debridement while providing a perspective as to diagnosis and the particulars of how intraoperative factors such as intraarticular irrigation can play pivotal roles in infection eradication. By providing a perspective on current debridement practices, we hope to encourage future study and debate on how to address periprosthetic joint infections best.

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“…Previous studies have showed that α defensin was a promising biomarker for PJI diagnosis; 16,17 the Synovial α Defensin Lateral Flow test (Synovasure; Zimmer-Biomet, USA) has been developed and was approved by the USA Food and Drug Administration (FDA). However, its diagnostic value in PJI is still controversial, 18,19 with a considerably large scope of sensitivities (from 67% to 100%) and specificities (from 68% to 100%) according to previous reports. 16,17,20 In recent research performed by Ivy et al, 18 the diagnostic value of synovial α defensin in PJI was not superior to that of synovial white blood cell (WBC) count and polymorphonuclear neutrophil percentage (PMN%), but its test costs were higher than synovial WBC and PMN% test.…”

Section: Introductionmentioning

confidence: 99%

Synovial fluid neutrophil extracellular traps could improve the diagnosis of periprosthetic joint infection

Cai

Liang

Chen

et al. 2023

Bone & Joint Research

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Aims This study aimed to explore the diagnostic value of synovial fluid neutrophil extracellular traps (SF-NETs) in periprosthetic joint infection (PJI) diagnosis, and compare it with that of microbial culture, serum ESR and CRP, synovial white blood cell (WBC) count, and polymorphonuclear neutrophil percentage (PMN%). Methods In a single health centre, patients with suspected PJI were enrolled from January 2013 to December 2021. The inclusion criteria were: 1) patients who were suspected to have PJI; 2) patients with complete medical records; and 3) patients from whom sufficient synovial fluid was obtained for microbial culture and NET test. Patients who received revision surgeries due to aseptic failure (AF) were selected as controls. Synovial fluid was collected for microbial culture and SF-WBC, SF-PNM%, and SF-NET detection. The receiver operating characteristic curve (ROC) of synovial NET, WBC, PMN%, and area under the curve (AUC) were obtained; the diagnostic efficacies of these diagnostic indexes were calculated and compared. Results The levels of SF-NETs in the PJI group were significantly higher than those of the AF group. The AUC of SF-NET was 0.971 (95% confidence interval (CI) 0.903 to 0.996), the sensitivity was 93.48% (95% CI 82.10% to 98.63%), the specificity was 96.43% (95% CI 81.65% to 99.91%), the accuracy was 94.60% (95% CI 86.73% to 98.50%), the positive predictive value was 97.73%, and the negative predictive value was 90%. Further analysis showed that SF-NET could improve the diagnosis of culture-negative PJI, patients with PJI who received antibiotic treatment preoperatively, and fungal PJI. Conclusion SF-NET is a novel and ideal synovial fluid biomarker for PJI diagnosis, which could improve PJI diagnosis greatly. Cite this article: Bone Joint Res 2023;12(2):113–120.

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Alpha-defensin does not provide additional benefit over leukocyte esterase in the diagnosis of periprosthetic joint infection

Cited by 7 publications

References 18 publications

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

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

A review of current practices in periprosthetic joint infection debridement and revision arthroplasty

Synovial fluid neutrophil extracellular traps could improve the diagnosis of periprosthetic joint infection

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