Novel diagnostic markers for periprosthetic joint infection: a systematic review

Abstract

BackgroundIdentifying novel biomarkers that are both specific and sensitive to periprosthetic joint infection (PJI) has the potential to improve diagnostic accuracy and ultimately enhance patient outcomes. Therefore, the aim of this systematic review is to identify and evaluate the effectiveness of novel biomarkers for the diagnosis of PJI.MethodsWe searched the MEDLINE, EMBASE, PubMed, and Cochrane Library databases from January 1, 2018, to September 30, 2022, using the search terms “periprosthetic joint infection,” “prosthetic joint infection,” or “periprosthetic infection” as the diagnosis of interest and the target index, combined with the term “marker.” We excluded articles that mentioned established biomarkers such as CRP, ESR, Interleukin 6, Alpha defensin, PCT (procalcitonin), and LC (leucocyte cell count). We used the MSIS, ICM, or EBJS criteria for PJI as the reference standard during quality assessment.ResultsWe collected 19 studies that analyzed fourteen different novel biomarkers. Proteins were the most commonly analyzed biomarkers (nine studies), followed by molecules (three studies), exosomes (two studies), DNA (two studies), interleukins (one study), and lysosomes (one study). Calprotectin was a frequently analyzed and promising marker. In the scenario where the threshold was set at ≥50-mg/mL, the calprotectin point-of-care (POC) performance showed a high sensitivity of 98.1% and a specificity of 95.7%.ConclusionNone of the analyzed biomarkers demonstrated outstanding performance compared to the established parameters used for standardized treatment based on established PJI definitions. Further studies are needed to determine the benefit and usefulness of implementing new biomarkers in diagnostic PJI settings.

Interleukin-1β Polymorphisms Are Genetic Markers of Susceptibility to Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty

“…Nonetheless, the infection may persist and evolve towards antimicrobial resistance, thus forcing patients into a (sometime life-long) therapy odyssey. The identification of novel specific and highly sensitive biomarkers would allow for a more rapid and accurate diagnosis and treatment of PJIs, possibly improving patient outcomes [36]. In particular, the identification of genetic variability (e.g., SNPs) associated with susceptibility to PJIs might allow for the establishment timely preventative measures.…”

Active myeloperoxidase: a promising biomarker to differentiate “acute” and “low-grade” peri-prosthetic joint infections from aseptic failures

“…Several biomarkers derived from neutrophils, including leukocyte esterase (LE), alpha-defensin and calprotectin, have recently been evaluated as an aid in the diagnosis of PJI ( Renz et al, 2018 ; Grassi et al, 2022 ; Schindler et al, 2023 ). However, their diagnostic performance, is highly variable depending on the chosen PJI definition, with a poorer consistency with EBJIS criteria compared to Musculoskeletal Infection Society (MSIS) algorithm ( Vale et al, 2023 ).…”

Hybrid Impedimetric Biosensors for Express Protein Markers Detection

“…That is why the detection and quantification of proteins in biological fluids is very important for the diagnosis and monitoring of various diseases such as cancer, infections, autoimmune diseases, allergies, etc. [1][2][3][4][5][6][7][8]. It is noted that for accurate and timely identification of the disease, it is necessary to determine a diagnostically important group of protein markers [9][10][11], which allows specialists to choose efficient treatment tactics.…”