What Is the Optimal Criteria to Use for Detecting Periprosthetic Joint Infections Before Total Joint Arthroplasty?

Kanwar, Sumit; Al-Mansoori, Ahmed; Chand, Mohit; Villa, Jesus M.; Suárez, Juan C.; Patel, Preetesh D.

doi:10.1016/j.arth.2018.02.072

Cited by 20 publications

(12 citation statements)

References 24 publications

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“…This concern has been focused primarily on the results of studies that questioned the benefit of determining AD from synovial fluid, where, in particular, sensitivity was lower and varied in comparison with previous results. For the lateral flow method, sensitivity is between 67% and 100% and specificity 94% to 97% [11,12,16,21].…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate cutoff concentration settings are stipulated by accurate diagnoses from a patient population. In the case of PJI, the Musculoskeletal Infection Society (MSIS) criteria seem to comprise the most objective set of cutoff levels [2,[16][17][18]. For the lateral flow method, the cutoff for AD concentration for PJI is set to 5.2 mg/L [4,5,10].…”

Section: Introductionmentioning

confidence: 99%

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High-Performance Liquid Chromatography as a Novel Method for the Determination of α-Defensins in Synovial Fluid for Diagnosis of Orthopedic Infections

et al. 2020

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The α-defensins (AD) present in synovial fluid have been regarded as constituting the most accurate periprosthetic joint infection (PJI) biomarker. The methods most commonly used for estimating AD as a biomarker are the qualitative Synovasure® PJI tests, based on the technique of lateral flow, and quantitative enzyme-linked immunosorbent assay (ELISA). Here, we propose a novel test based on detecting α-defensins in synovial fluid by high-performance liquid chromatography (HPLC). Synovial fluid was collected from 157 patients diagnosed with PJI, infectious arthritis (IA), arthrosis, reactive arthritis, and rheumatoid arthritis. AD concentrations in the fluid were determined by HPLC, and these same samples were used for additional diagnostic analyses. The results were statistically processed to calculate cutoff concentrations for PJI and IA. HPLC testing showed a sensitivity of 94% and a specificity of 92% for diagnosis of PJI, and a sensitivity of 97% and a specificity of 87% for diagnosis of IA. Using HPLC, we detected in synovial fluid a combination of three α-defensins: human neutrophil peptides HNP1, HNP2, and HNP3. All measured AD concentration values shown in this work refer to the sum of these three individual concentrations. Our study shows that the HPLC method meets the conditions for measuring precise concentrations of the sum of AD and can be recommended as part of a diagnostic array for PJI and IA diagnostics. By this method, we have verified that higher levels of AD in synovial fluid can also be seen in rheumatoid illnesses, crystal arthropathies, and reactive arthritis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-Performance Liquid Chromatography as a Novel Method for the Determination of α-Defensins in Synovial Fluid for Diagnosis of Orthopedic Infections

et al. 2020

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“…With a higher specificity than sensitivity in almost every study examined, measurement of alpha defensin level is useful as a confirmatory test, but not a good procedure to rule out diagnosis of PJI or as the sole detection procedure [5,8]. When combined with culturing, sensitivity and specificity reach 96% and 100%, respectively [57]. Alpha defensin may miss infections with low-virulence organisms such as coagulase negative CoNS or C. acnes, with up to an 80% false negative rate [21,58].…”

Section: Alpha Defensinmentioning

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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“…The use of [ 67 Ga]Ga-citrate is limited by the long half-life (T 1/2 = 78.3 h) and the need for repeated imaging over several days [10,13]. It is still di cult to distinguish between PJI and AL on [ 18 F]FDG PET/CT, and its high cost and the requirement for fasting before PET imaging limit its clinical application [4,9]. At present, the diagnosis of PJI and AL depends predominantly on methods facilitated by surgery such as histological analysis and intraoperative microbial culture [14].…”

Section: Introductionmentioning

confidence: 99%

“…Various clinical assessment methods are currently used to con rm the diagnosis, including laboratory examination, X-ray examination, CT imaging, MRI, bone scan, [ 67 Ga]Ga-citrate imaging, radioactivelabelled leukocyte scintigraphy, [ 18 F]FDG PET/CT imaging, joint aspiration, and microbial culture[3,4,7,25]. However, routine laboratory tests and imaging examinations often provide non-speci c results, and joint aspiration may not be successful[1,3,5,9,26]. Nuclear medicine imaging is considered one of the most valuable methods for the diagnosis of PJI and AL[3].…”

mentioning

confidence: 99%

Application of [68Ga]Ga-citrate PET/CT for Differentiating Prosthetic Joint Infection from Aseptic Loosening After Joint Replacement Surgery

Yun

Yang

et al. 2020

Preprint

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Purpose Preoperative differentiation of prosthetic joint infection (PJI) and aseptic loosening (AL) is challenging. We aimed to evaluate the utility of visual analysis and semi-quantitative parameters of [68Ga]Ga-citrate positron emission tomography/computed tomography (PET/CT) in the differentiation of PJI and AL. Methods Sixteen patients with suspected PJI or AL underwent [68Ga]Ga-citrate PET/CT imaging. Results were evaluated by three nuclear medicine doctors based on (1) visual analysis of the attenuation correction (AC) and non-attenuation correction (NAC) based on tracer uptake intensity and range; (2) maximum standard uptake value (SUVmax) of lesions and the SUVmax of the target area/SUVmax of the non-target area (bone and muscle; T/NT [bone] and T/NT [muscle]). The final diagnosis was based on the Musculoskeletal Infection Society criteria, intraoperative findings, and histopathological and microbiological examinations. Results Overall, 10 (62.5%) and 6 (37.5%) patients were diagnosed with PJI and AL, respectively. Receiver operating characteristic analysis revealed that the areas under the curve for SUVmax, T/NT (bone), and T/NT (muscle) were 0.617 (cut-off = 2.243, P = 0.4312), 0.850 (cut-off = 2.844, P = 0.0052), and 0.850 (cut-off = 5.983, P = 0.0003), respectively. AC, NAC, and T/NT (bone) exhibited high differential diagnostic values (sensitivity, specificity, and accuracy of 90.0%, 83.3%, and 87.5%, respectively). The diagnostic efficacy of T/NT (muscle) was the second highest (sensitivity, specificity, and accuracy of 60.0%, 100%, and 75.0%, respectively). SUVmax demonstrated the poorest diagnostic efficacy (sensitivity, specificity, and accuracy of 70.0%, 66.7%, and 68.8%, respectively). Conclusion Our results suggest that [68Ga]Ga-citrate may differentiate PJI and AL.

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What Is the Optimal Criteria to Use for Detecting Periprosthetic Joint Infections Before Total Joint Arthroplasty?

Cited by 20 publications

References 24 publications

High-Performance Liquid Chromatography as a Novel Method for the Determination of α-Defensins in Synovial Fluid for Diagnosis of Orthopedic Infections

High-Performance Liquid Chromatography as a Novel Method for the Determination of α-Defensins in Synovial Fluid for Diagnosis of Orthopedic Infections

Current Clinical Methods for Detection of Peri-Prosthetic Joint Infection

Application of [68Ga]Ga-citrate PET/CT for Differentiating Prosthetic Joint Infection from Aseptic Loosening After Joint Replacement Surgery

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