The 2013 Frank Stinchfield Award: Diagnosis of Infection in the Early Postoperative Period After Total Hip Arthroplasty

Yi, Paul H.; Cross, Michael B.; Moric, Mario; Sporer, Scott M.; Berger, Richard A.; Valle, Craig J. Della

doi:10.1007/s11999-013-3089-1

Cited by 104 publications

(84 citation statements)

References 26 publications

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“…The synovial white blood-cell count typically shows sensitivity of 84% to 93% and specificity of 51% to 100% [33][34][35][36] . The proportion of synovial white blood cells that are polymorphonuclear, and thus concerned with fighting infection, typically shows sensitivity of 81% to 93% and specificity of 69% to 83% [33][34][35][36] . While C-reactive protein in serum may have high sensitivity and poor specificity for PJI, measurement in synovial fluid shows sensitivity of 96% to 97% and specificity of 90% to 93% 27,37 .…”

Section: Discussionmentioning

confidence: 99%

“…The age ranges and proportions of male patients were similar among studies, but information on the time since arthroplasty was highly limited. This may be important as some biomarkers may have different diagnostic accuracy in the early postoperative period 36 . Future studies should aim to assess differences in diagnostic accuracy relating to potential sources of heterogeneity, including arthroplasty site, time since index surgery, and patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

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The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Wyatt

Beswick

Kunutsor

et al. 2016

The Journal of Bone and Joint Surgery

177

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Background: Synovial biomarkers have recently been adopted as diagnostic tools for periprosthetic joint infection (PJI), but their utility is uncertain. The purpose of this systematic review and meta-analysis was to synthesize the evidence on the accuracy of the alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of PJI compared with the Musculoskeletal Infection Society diagnostic criteria. Methods: We performed a systematic review to identify diagnostic technique studies evaluating the accuracy of alpha-defensin or leukocyte esterase in the diagnosis of PJI. MEDLINE and Embase on Ovid, ACM, ADS, arXiv, CERN DS (Conseil Européen pour la Recherche Nucléaire Document Server), CrossRef DOI (Digital Object Identifier), DBLP (Digital Bibliography & Library Project), Espacenet, Google Scholar, Gutenberg, HighWire, IEEE Xplore (Institute of Electrical and Electronics Engineers digital library), INSPIRE, JSTOR (Journal Storage), OAlster (Open Archives Initiative Protocol for Metadata Harvesting), Open Content, Pubget, PubMed, and Web of Science were searched for appropriate studies indexed from inception until May 30, 2015, along with unpublished or gray literature. The classification of studies and data extraction were performed independently by 2 reviewers. Data extraction permitted meta-analysis of sensitivity and specificity with construction of receiver operating characteristic curves for each test. Results: We included 11 eligible studies. The pooled diagnostic sensitivity and specificity of alpha-defensin (6 studies) for PJI were 1.00 (95% confidence interval [CI], 0.82 to 1.00) and 0.96 (95% CI, 0.89 to 0.99), respectively. The area under the curve (AUC) for alpha-defensin and PJI was 0.99 (95% CI, 0.98 to 1.00). The pooled diagnostic sensitivity and specificity of leukocyte esterase (5 studies) for PJI were 0.81 (95% CI, 0.49 to 0.95) and 0.97 (95% CI, 0.82 to 0.99), respectively. The AUC for leukocyte esterase and PJI was 0.97 (95% CI, 0.95 to 0.98). There was substantial heterogeneity among studies for both diagnostic tests. Conclusions: The diagnostic accuracy for PJI was high for both tests. Given the limited number of studies and the large cost difference between the tests, more independent research on these tests is warranted. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Wyatt

Beswick

Kunutsor

et al. 2016

The Journal of Bone and Joint Surgery

177

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“…Acute infection was defined as presentation within 6 weeks of an index procedure [3,10,13,28,30,34] and any infection beyond that time was classified as chronic. The patients in the infected and noninfected groups had similar demographics [7] ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Tetreault

Wetters

Moric

et al. 2014

Clin Orthop Relat Res

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100

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Background Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI). Questions/purposes We aimed to (1) determine if there is a correlation between serum and synovial CRP values, (2) establish cutoff values for diagnosing infection based on serum and synovial CRP, and (3) compare the utility of measuring CRP in synovial fluid versus serum for the diagnosis of PJI using standard assay equipment available at most hospitals. Methods Between February 2011 and March 2012, we invited all 150 patients scheduled for revision TKA (84) or THA (66) to participate in this prospective study, of whom 100% agreed. Data ultimately were missing for 31 patients, leaving 60 patients undergoing revision TKA and 59 undergoing revision THA (71% and 89% of the original group, respectively) for whom CRP level was measured in serum and synovial fluid samples. Patients were deemed to have a PJI (32) or no infection (87) using Musculoskeletal Infection Society criteria. Serum and synovial CRP levels were assayed using the same immunospectrophotometer and the correlation coefficient was calculated. Receiver operating characteristic curve analyses were performed to compare utility in diagnosing PJI, which included area under the curve, diagnostic threshold, and test sensitivity, specificity, predictive values, and accuracy. In 22 of 150 patients (14.7%), synovial CRP could not be measured because the sample was too viscous or hemolyzed. Results In the analyzed 119 samples, there was a strong correlation (r = 0.76; p \ 0.001) between synovial and serum CRP. The area under the curve was 0.90 both for the synovial fluid (95% CI, 0.82-0.97) and serum (95% CI, 0.84-0.96) CRP assays. The diagnostic thresholds were 6.6 mg/L for synovial fluid and 11.2 mg/L for serum. Sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were similar for synovial fluid and serum assays. Conclusions Although recent studies have suggested a superiority of synovial fluid CRP over serum CRP for the diagnosis of PJI, we found that measurement of CRP in synovial fluid rather than serum using readily available

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“…All revisions were performed between May 1, 2004, and August 1, 2014. Fifteen hips (9%) were excluded from our analysis because of prior surgery within 6 weeks before the revision (nine hips) [1,36], oral or intravenous antibiotics given withinsuggestive of acute hematogenous infection (three hips). Neither inflammatory arthropathy [5] nor the administration of prophylactic antibiotics before incision during revision surgery [30] The upper limits of normal for serum ESR and CRP in our institution's laboratory are 27 mm/hr and 8.0 mg/L, respectively.…”

Section: Methodsmentioning

confidence: 99%

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Cross

Moric

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The diagnosis of periprosthetic joint infection (PJI) in patients with failed metal-on-metal (MoM) bearings and corrosion reactions in hip arthroplasties can be particularly difficult, because the clinical presentation of adverse local tissue reactions may mimic that of PJI, because it can also occur concurrently with PJI, and because common laboratory tests used to diagnose PJI may be elevated in patients with MoM THAs. Questions/purposes We sought to determine the test properties of the serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count, and synovial fluid differential (percent polymorphonuclear cells [PMNs]) in diagnosing One of the authors certifies that he (CJDV), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Biomet, Inc (Warsaw, IN, USA), an amount less than USD 10,000 from Convatec (Skillman, NJ, USA), an amount of USD 10,000 to USD 100,000 from DePuy (Warsaw, IN, USA), an amount of USD 10,000 to USD 100,000 from Smith & Nephew, Inc (Memphis, TN, USA), and an amount of USD 10,000 to USD 100,000 from CD Diagnostics (Wynnewood, PA, USA). One of the authors certifies that he (CJDV), or a member of his or her immediate family, has or may receive funding, during the study period, an amount USD 10,000 to USD 100,000 from Stryker (Kalamazoo, MI, USA). One of the authors certifies that he (BRL), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from CONMED Linvatec (San Mateo, CA, USA), an amount of USD 10,000 to USD 100,000 from DePuy, an amount of USD 10,000 to USD 100,000 from Biomet, Inc, an amount of USD 10,000 to 100,000, from Zimmer, Inc (Warsaw, IN, USA), an amount of less than USD 10,000 from Janssen Pharmaceuticals (Beerse, Belgium), and an amount of less than USD 10,000 from Orthoview (Jacksonville, FL, USA). One of the authors certifies that he (SMS), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to 100,000, from Zimmer, Inc, an amount of USD 10,000 to 100,00 from Cadence Health (Winfield, IL, USA), an amount of USD 10,000 to USD 100,000 from Smith & Nephew, Inc, and an amount of less than USD 10,000 from SLACK Incorporated (Thorofare, NJ, USA). One of the authors (WGP) certifies that he has received or may receive payments or benefits, during the study period, an amount of USD 100,001-USD 1,000,000, from Zimmer, Inc, an amount of USD 100,001 to USD 1,000,000, from Stryker, an amount of USD 100,001 to USD 1,000,000, from DePuy, an amount of less than USD 10,000 from Medtronic (Minneapolis, MN, USA), and an amount of USD 10,000 to USD 1,000 from Lippincott (Philadelphia, PA, USA). One of the authors (JJJ) certifies that he has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from ...

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The 2013 Frank Stinchfield Award: Diagnosis of Infection in the Early Postoperative Period After Total Hip Arthroplasty

Abstract: Optimal cutoff values for the diagnosis of PJI in the acute postoperative period were higher than those traditionally used for the diagnosis of chronic PJI. The serum CRP is an excellent screening test, whereas the synovial fluid WBC count is more specific.

Cited by 104 publications

References 26 publications

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

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