Comparative analysis of 23 synovial fluid biomarkers for hip and knee periprosthetic joint infection detection

Abstract

There is interest in novel synovial fluid biomarkers for the detection of periprosthetic joint infection (PJI). Here, we assessed the diagnostic accuracy of 23 simple or sophisticated synovial fluid biomarkers for periprosthetic hip or knee infection detection. One hundred seven subjects were studied, 57 of whom had aseptic failure (AF) and 50 PJI. The following synovial fluid biomarkers were tested using spectrophotometric assays, immunoassays, lateral flow tests, or test strips: leukocyte count, monocyte percentage, lymphocyte percentage, neutrophil percentage, C‐reactive protein (CRP), glucose, lactate, granulocyte‐macrophage colony‐stimulating factor, interferon‐γ, interleukin‐1β (IL‐1β), IL‐2, IL‐4, IL‐5, IL‐6, IL‐8, IL‐10, IL‐12p70, IL‐13, IL‐17A, IL‐23, tumor necrosis factor‐α, α‐defensin, and leukocyte esterase. The best‐performing synovial fluid biomarkers to differentiate PJI from AF—that is, those with highest area under the curve compared to all other biomarkers—were leukocyte count, percent neutrophils and percent monocytes, CRP, and α‐defensin (P < .0001).

Increased Diagnostic Certainty of Periprosthetic Joint Infections by Combining Microbiological Results with Histopathological Samples Gained via a Minimally Invasive Punching Technique

“…The arthrocentesis is one of the standard diagnostic procedures. In addition to microbiological cultural bound analyses, the synovial fluid can be examined for cell count or synovial fluid biomarkers [ 7 ] and microbiological multiplex polymerase chain reaction (PCR) approaches. The latter technique allows for rapid pathogen detection, also in combination with the detection of selected molecular antibiotic resistance markers [ 8 , 9 ].…”

Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection

“…Synovial interleukin-6 studies. six studies described the diagnostic accuracy of synovial fluid IL6 in the detection of PJI, using the msis criteria as the standard reference test, [32][33][34][35][36][37] with baseline characteristics of individual studies shown in table iii. The overall sensitivity was 0.86 (95% CI 0.74 to 0.92), specificity was 0.94 (95% ci 0.90 to 0.96), Plr was 13.7 (95% ci 8.6 to 21.6), nlr was 0.15 (95% ci 0.08 to 0.28), and dOr was 89 (95% ci 37 to 214).…”

Diagnostic accuracy of synovial fluid D-lactate for periprosthetic joint infection: a systematic review and meta-analysis

“…First, we searched the databases and removed duplicate records, identifying a total of 169 records. Then, an initial screening of titles and abstracts was performed, resulting in 21 articles that met the precriteria, and 5 articles [ 9 , 10 , 14 – 16 ] were finally included for quantitative analysis after further evaluation. Figure 1 shows the selection process of the included studies.…”

“…Five studies including a total of 1087 patients (253 patients by PJI) were included in the systematic review to explore the diagnostic accuracy of D-lactate; four studies [ 9 , 10 , 14 , 16 ] were prospective, and one study [ 15 ] was retrospective. Three studies [ 9 , 10 , 14 ] used a D-lactate kit (VL-Diagnostics, Leipzig, Germany) to assess D-lactate, and two studies [ 15 , 16 ] did not give a test method. The average age of the patients included in the study was 66.4–69.5 years, and the proportion of males ranged from 44.6 to 54.7%.…”