Preoperative PCR analysis of synovial fluid has limited value for the diagnosis of periprosthetic joint infections of total knee arthroplasties

Fink, Bernd; Steurer, Markus; Hofäcker, Sigrid; Schäfer, Peter; Sandow, D; Schuster, Philipp; Oremek, Damian

doi:10.1007/s00402-018-2924-y

Cited by 18 publications

(19 citation statements)

References 39 publications

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“…The false positive PCR results may be due to contamination in the surgery process by skin, vials used for collection of samples or by the presence of 16S rRNA from nonviable bacteria present in sterilized medical devices (23,30,43). Contaminants can also be introduced during the PCR reaction by reagents and equipment (44,45). The heterogeneity found by the present meta-analysis was likely due to clinical sample, study design, center, blinded status and the country used for PCR diagnosis.…”

Section: Discussionmentioning

confidence: 87%

Advantages of 16S rRNA PCR for the diagnosis of prosthetic joint infection

et al. 2020

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16S ribosomal RNA (rRNA) PCR has been reported to be an effective diagnostic means in patients with prosthetic joint infection (PJI). The aim of the present meta-analysis is to establish the overall diagnostic accuracy of the measurement of 16S rRNA PCR for diagnosing PJI. PubMed, Web of Science, Cochrane Library, EMBASE and Wiley Online Library were searched for studies on 16S rRNA PCR in the diagnosis of PJI. The search incorporated all literature published up until December 2018 and the QUADAS-2 checklist were used for quality assessment. The sensitivity, specificity and other measures of accuracy of 16S rRNA PCR in the diagnosis of PJI were pooled. Statistical analysis was performed by employing Meta-Disc 1.4 and Stata 12.0 software. A total of 15 studies met the inclusion criteria. The summary estimates for 16S rRNA PCR in the diagnosis of PJI in these studies were pooled: Sensitivity, 0.70 (95% CI, 0.67-0.73); specificity, 0.93 (95% CI, 0.91-0.94); positive likelihood ratio, 10.93 (95% CI, 5.55-21.51); negative likelihood ratio, 0.33 (95% CI, 0.28-0.40); diagnostic odds ratio, 41.77 (95% CI, 19.90-87.68); and the area under the curve, 0.89. Subgroup analysis showed that the use of sonicate fluid and periprosthetic tissue has higher sensitivity (0.76; 95% CI, 0.69-0.82; and 0.73; 95% CI, 0.68-0.78, respectively), specificity (0.93, 95% CI, 0.90-0.96; and 0.95; 95% CI, 0.90-0.98, respectively) and area under the curve (0.93 and 0.98, respectively). 16S rRNA PCR assay plays an important role in the diagnosis of PJI. The results of 16S rRNA PCR assays should be interpreted in parallel with clinical findings, the results of microbiological, and other laboratory tests.

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Section: Discussionmentioning

confidence: 87%

Advantages of 16S rRNA PCR for the diagnosis of prosthetic joint infection

et al. 2020

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“…These values were compara-tively less than or equal to those found for culture and CRP values of the same samples. Even with the additional fungal primer, pre-operative synovial fluid testing did not add diagnostic value [41].…”

Section: Pcr Diagnosismentioning

confidence: 95%

“…Peri-prosthetic joint infection is not only caused by bacterial colonization but can also occur from fungal presence. Real-time PCR utilizing additional primers such as 28S rRNA [40] or 18S rRNA [41] allow for the detection of fungal and eukaryotic presence. The PCR run with an 18S rRNA primer on a synovial fluid sample taken pre-operatively had a sensitivity of 55.6% and specificity of 82.0% in detection of either bacterial or fungal PJI.…”

Section: Pcr Diagnosismentioning

confidence: 99%

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

Berns

Barrett

Gardezi

et al. 2020

Surgical Infections

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Background: Currently, one of the most pressing problems in the field of orthopedic surgery is peri-prosthetic joint infection [PJI]. While there are numerous ways to detect PJI, current clinical detection methods differ across institutions and have varying criteria and protocols. Some of these methods include the Modified Musculoskeletal Infection Society system, culturing, polymerase chain reaction, the determination of the presence of certain biomarkers, testing for the presence of alpha defensin peptides, and leukocyte level testing. Methods: This review summarizes the most recent publications in the field of PJI detection to highlight current strengths as well as provide future directions to find the system for the quickest, cost-effective, and most accurate way to diagnose these types of infections. Results: The results of this literature review suggest that, while each method of diagnosis has its advantages, each has various drawbacks as well. Current methods can be expensive, take days to weeks to complete, be prone to contamination, and can produce ambiguous results. Conclusions: The findings in this review emphasize the need for a more comprehensive and accurate system for diagnosing PJI. In addition, the specific comparison of advantages and drawbacks can be useful for researchers and clinicians with goals of creating new diagnostic tests for PJIs, as well as in clinical scenarios to determine the correct treatment for patients.

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“…Therefore we recommend performing a joint aspiration before revision surgery of a loosened or painful joint prosthesis. Furthermore, we recommend using a combination of different tests such as cultivation, alpha-defensin or cell count, because no single diagnostic analysis has an accuracy of 100% [21,22].…”

Section: Table 1 Number Of Detected Speciesmentioning

confidence: 99%

C-reactive protein is not a screening tool for late periprosthetic joint infection

Fink

Schlumberger²,

Beyersdorff

et al. 2020

J Orthop Traumatol

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Background: Preoperative diagnosis of periprosthetic joint infection (PJI) is important because of the therapeutic consequences. The aim of the present study is to investigate whether the serum C-reactive protein (CRP) level can be used as a screening tool for late PJI. Materials and methods: A cohort of 390 patients with revision surgery of total hip prostheses (200) or total knee prostheses (190) was assessed for late PJI by determining CRP serum level and performing preoperative aspiration with cultivation and intraoperative tissue analyses with cultivation and histologic examination, using the Musculoskeletal Infection Society (MSIS) and International Consensus Meeting (ICM) criteria. Results: A total of 180 joints were rated as PJI (prevalence 46%). Of these, 42.8% (77) showed a CRP level below 10 mg/L and 28.3% (51) showed a normal CRP level of less than 5 mg/L. The 76.9% of the cases with slow-growing bacteria showed a CRP level below 10 mg/L, and 61.5% showed a normal CRP level. Conclusions: Serum CRP level should not be used as a screening tool to rule out late PJI.

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Preoperative PCR analysis of synovial fluid has limited value for the diagnosis of periprosthetic joint infections of total knee arthroplasties

Cited by 18 publications

References 39 publications

Advantages of 16S rRNA PCR for the diagnosis of prosthetic joint infection

Advantages of 16S rRNA PCR for the diagnosis of prosthetic joint infection

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

C-reactive protein is not a screening tool for late periprosthetic joint infection

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