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Alpha-defensin-novel synovial fluid biomarker for the diagnosis of periprosthetic joint infection
Jakrapun Pupaibool1, Eric J Fulnecky2, Robert L Swords2
1Division of Infectious Diseases, Department of Internal Medicine, Mercy Hospital, 2115 S. Fremont, Suite 3050, Whiteside Building, Springfield, MO, 65804, USA. jakrapun.pupaibool@mercy.net.
Purpose:
Periprosthetic joint infection (PJI) continues to be a significant complication after total joint arthroplasty. Diagnosis of PJI can be challenging and elusive in the absence of a gold standard. This purpose of this article is to review the current evidence on the utility of serum and synovial fluid biomarkers to help aid in the diagnosis of PJI with focusing on synovial fluid alpha-defensin.
Methods:
Articles and data for this review were identified by searches of PubMed and Ovid MEDLINE up to June 1, 2016. In addition, we manually reviewed the bibliographies of the retrieved articles for additional citations for references from relevant articles on the diagnosis of PJI.
Results:
Serum biomarkers can be elevated in various inflammatory conditions. Synovial fluid biomarkers are more accurate for the diagnosis of PJI compared to serum biomarkers. Based on current available data, alpha-defensin is the most promising synovial fluid biomarker for the diagnosis of PJI and is commercially available.
Conclusions:
Synovial fluid alpha-defensin could enhance our ability to identify PJI and incorporate into the diagnostic algorithm in the future. Large-scale studies are needed to provide more data for its significance for the diagnosis of PJI.
Insights
Diagnosing periprosthetic joint infection (PJI) is challenging. Synovial fluid alpha-defensin shows promise as a biomarker for PJI, potentially improving diagnostic accuracy.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomarker Research
Background:
- Periprosthetic joint infection (PJI) is a major complication following total joint arthroplasty.
- Accurate diagnosis of PJI remains challenging due to the lack of a definitive gold standard.
Purpose of the Study:
- To review current evidence on serum and synovial fluid biomarkers for PJI diagnosis.
- To focus on the utility of synovial fluid alpha-defensin in diagnosing PJI.
Main Methods:
- Literature search of PubMed and Ovid MEDLINE up to June 1, 2016.
- Manual review of bibliographies from retrieved articles for relevant citations.
Main Results:
- Synovial fluid biomarkers are more accurate for PJI diagnosis than serum biomarkers.
- Alpha-defensin in synovial fluid is identified as the most promising biomarker for PJI diagnosis.
- Alpha-defensin is commercially available for diagnostic use.
Conclusions:
- Synovial fluid alpha-defensin has the potential to improve PJI identification.
- Further large-scale studies are required to establish the full significance of alpha-defensin in PJI diagnosis.
