Are Accuracy Studies for Periprosthetic Joint Infection Diagnosis Inherently Flawed? And What to Do with Schrödinger’s Hips? A Prospective Analysis of the Alpha Defensin Lateral-Flow Test in Chronic Painful Hip Arthroplasties

Abstract

Purpose The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alpha-defensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain “Schrödinger’s hips”: in such cases PJI cannot be excluded nor confirmed until you “open the box”. Results The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of “Schrödinger’s hips”.

Validation of Synovial Fluid Clinical Samples for Molecular Detection of Pathogens Causing Prosthetic Joint Infection Using GAPDH Housekeeping Gene as Internal Control

“…UKA offers superior survivability, while HTO can delay total knee arthroplasty (TKA) by improving joint alignment and preservation (Takeuchi et al, 2010;Fu et al, 2013). The criteria for determining PJIs are important, and the 2013 Musculoskeletal Infection Society (MSIS), 2018 International Consensus Meeting (ICM), and modified MSIS criteria are defined as the criteria for determining PJIs (Parvizi et al, 2018;Patel et al, 2023;Kuiper et al, 2022). Currently, the modified MSIS criteria, which include two major and several minor criteria, are most commonly used to determine PJIs.…”

“…Currently, the modified MSIS criteria, which include two major and several minor criteria, are most commonly used to determine PJIs. The modified MSIS includes positive cultures, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of serum, white blood cell (WBC) count, leukocyte esterase (LE), polymorphonuclear neutrophil (PMN) from synovial fluid (SF), and histological analysis (Kuiper et al, 2022;Zmistowski et al, 2014).…”

Risk factors for early septic failure after two-stage exchange total knee arthroplasty for treatment of periprosthetic joint infection

“…Among these, two-stage exchange revision total knee arthroplasty is currently the gold standard treatment for chronic PJI after total knee arthroplasty. [ 2 , 7 – 11 ].…”

Application of Multi-Layered Temperature-Responsive Polymer Brushes Coating on Titanium Surface to Inhibit Biofilm Associated Infection in Orthopedic Surgery

“…As mature biofilms are resistant to systemic antibiotics and the host immune system, subsequent surgery is often necessary, which involves removal of the implant and reinsertion once the infection has been eradicated. Such complications can be observed after any implant insertion surgery, such as arthroplasty or fracture fixation, resulting in significant costs and morbidity for the patient [ 8 , 9 ].…”