Synovial Fluid Biomarkers for Periprosthetic Infection

Deirmengian, Carl; Hallab, Nadim J.; Tarabishy, Abdul; Valle, Craig Della; Jacobs, Joshua J.; Lonner, Jess H.; Booth, Robert E.

doi:10.1007/s11999-010-1298-4

Cited by 173 publications

(118 citation statements)

References 16 publications

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“…(3) What is the accuracy of synovial fluid cytokines and the Musculoskeletal Infection Society (MSIS) criteria to rule out PJI after first-stage explantation? (4) What are the most studied synovial fluid cytokines for diagnosing PJI as reported in the literature and what are their cumulative diagnostic accuracy? Methods Between May 2013 and March 2014, 104 patients with painful THA and TKA evaluated for possible PJI were included in our study.…”

Section: Introductionmentioning

confidence: 99%

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Frangiamore

Siqueira

Saleh

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Diagnosing periprosthetic joint infection (PJI) requires a combination of clinical and laboratory parameters, which may be expensive and difficult to interpret. Synovial fluid cytokines have been shown to accurately differentiate septic from aseptic failed total knee (TKA) and hip (THA) arthroplasties. However, after firststage explantation, there is still no reliable test to rule out PJI before a second-stage reimplantation procedure. Questions/purposes (1) Which synovial fluid cytokines have the highest diagnostic accuracy for PJI? (2) Which cytokine shows the greatest decrease associated with the resolution of infection in the same patient between explantation and subsequent reimplantation of an infected arthroplasty? (3) What is the accuracy of synovial fluid cytokines and the Musculoskeletal Infection Society (MSIS) criteria to rule out PJI after first-stage explantation? (4) What are the most studied synovial fluid cytokines for diagnosing PJI as reported in the literature and what are their cumulative diagnostic accuracy? Methods Between May 2013 and March 2014, 104 patients with painful THA and TKA evaluated for possible PJI were included in our study. Of these, 90 (87%) had cytokine levels measured from synovial fluid samples collected as part of this prospective study (n = 33 hips, n = 57 knees). A second group of 35 patients (n = 36 samples) who presented during the same time period with an antibiotic spacer also had synovial cytokines measured before second-stage reimplantation. For the first group of 90 patients, the MSIS definition classified each joint at the time of surgery as infected (n = 31) or not infected (n = 59) and was used as the standard to test the accuracy in diagnosing PJI. Of the 35 patients with synovial marker data before second-stage surgery, 15 patients had cytokine measurements both at explantation and reimplantation and were used to quantify the change between stages. The reimplantation group had a minimum 1-year followup (with four [11%] patients lost to followup) and was classified into successful or failed treatment based on DelphiOne of the authors certifies that he (CAH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Stryker (Kalamazoo, MI, USA), an amount of USD 100,001 to USD 1,000,000 from KCI (San Antonio, TX, USA), an amount of USD 100,001 to USD 1,000,000 from Myoscience (Fresno, CA, USA), and an amount of USD 100,001 to USD 1,000,000 from CD Diagnostics (Claymont, DE, USA). One of the authors certifies that he (WKB), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker, an amount of USD 100,000 to USD 1,000,000 from Exatech (Gainesville, FL, USA), an amount of USD 10,000 to USD 100,000 from Custom Orthopaedic Solutions (Cleveland, OH, USA), and an amount of USD 10,000 to USD 100,000 from KEF Healthcare (Dubai, UAE). All ICMJE Conflict of Intere...

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Section: Introductionmentioning

confidence: 99%

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Frangiamore

Siqueira

Saleh

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Synovial biomarkers may provide such a test. A preliminary study showed that the AD-1 assay can quantitatively detect the level of the AD-1 biomarker in synovial fluid and may prove to be highly sensitive and specific for diagnosis of PJIs [2]. However no independent study has confirmed the use of the AD-1 assay in diagnosing a PJI.…”

Section: Discussionmentioning

confidence: 99%

“…Synovial fluid biomarkers such as cytokines, inflammatory proteins, and antimicrobial peptides may provide such a tool, but the best biomarker or combination of biomarkers has yet to be determined [2]. One biomarker, the alpha defensin-1 (AD-1) protein has shown promise [7].…”

Section: Introductionmentioning

confidence: 99%

The Alpha Defensin-1 Biomarker Assay can be Used to Evaluate the Potentially Infected Total Joint Arthroplasty

Bingham

Clarke

Spangehl

et al. 2014

Clin Orthop Relat Res

177

115

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Background Diagnosing a periprosthetic joint infection (PJI) requires a complex approach using various laboratory and clinical criteria. A novel approach to diagnosing these infections uses synovial fluid biomarkers. Alpha defensin-1 (AD-1) is one such synovial-fluid biomarker. However little is known about the performance of the AD-1 assay in the diagnosis of PJI. Questions/purposes We sought to (1) determine the sensitivity and specificity of the AD-1 assay in a population of patients being evaluated for PJI, using the Musculoskeletal Infection Society (MSIS) criteria as the reference standard, and (2) compare the AD-1 assay with other currently available clinical tests, specifically cell count, culture, erythrocyte sedimentation rate, and C-reactive protein.Patients and Methods A retrospective review was performed of all patients undergoing workup for a PJI at our institution from January to June 2013. Sixty-one AD-1 assays were done in 57 patients. The group included 51 patients with 55 painful joints and six patients who underwent aspiration before second-stage reimplantation. Patients were considered to have a PJI if they met the MSIS criteria. We calculated the sensitivity and specificity of the AD-1 synovial fluid assay, and compared it with the sensitivity and specificity of the synovial fluid cell count, culture, erythrocyte sedimentation rate, and C-reactive protein. There were 19 diagnosed infections in the 61 aspirations, with 21 positive and 40 negative AD-1 assays. There were two false positive and no false negatives AD-1 assays. Results The sensitivity and specificity for the AD-1 assay were 100% (95% CI, 79%-100%) and 95% (95% CI, 83%-99%), respectively. The sensitivity and specificity of the other tests ranged from 68% to 95% and 66% to 88%, respectively. The AD-1 assay results outperformed the other tests but did not reach statistical significance except for the sensitivity of the erythrocyte sedimentation rate. Conclusion The sensitivity and specificity of the synovial fluid AD-1 assay exceeded the sensitivity and specificity of the other currently available clinical tests evaluated here but did not reach significance. The AD-1 assay offers another test with high sensitivity and specificity for diagnosing a PJI especially in the case where the diagnosis of PJI is uncertain, but larger studies will be needed to determine significance and cost effectiveness. Level of Evidence Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

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“…We recognize there are numerous other tests currently being evaluated, including measurement of CRP from the synovial fluid [12], synovial leukocyte esterase [13], sonication of explanted prosthetics [17], and molecular techniques such as PCR [10] and other molecular markers such as IL-6 [2,4,6]. As these or other techniques become validated and widely available, the currently proposed definition may require modification.…”

Section: Future Developmentsmentioning

confidence: 99%

New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

Parvızı

Zmistowski

Berbari

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Synovial Fluid Biomarkers for Periprosthetic Infection

Cited by 173 publications

References 16 publications

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

The Alpha Defensin-1 Biomarker Assay can be Used to Evaluate the Potentially Infected Total Joint Arthroplasty

New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

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