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False-negative synovial alpha-defensin.

Jake R Adams¹, Adam J Schwartz¹

¹Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ, USA.

Arthroplasty Today

|December 6, 2017

Summary

This summary is machine-generated.

A case study highlights a false-negative alpha-defensin test in diagnosing chronic periprosthetic hip infection. The Musculoskeletal Infection Society criteria proved more reliable in this specific clinical scenario.

Keywords:

Alpha defensin Biomarker Periprosthetic joint infection Total hip arthroplasty

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Area of Science:

Orthopedics
Infectious Diseases
Diagnostic Biomarkers

Background:

Periprosthetic joint infection (PJI) is a serious complication following total hip arthroplasty.
Accurate diagnosis of chronic PJI is crucial for effective treatment and patient outcomes.
The alpha-defensin test has emerged as a promising biomarker for PJI diagnosis.

Observation:

This case report details a patient with chronic periprosthetic hip infection.
The infection was diagnosed using the established Musculoskeletal Infection Society (MSIS) criteria.
The alpha-defensin synovial fluid test yielded a false-negative result in this patient.

Findings:

The study presents the first reported instance of a false-negative alpha-defensin test in a patient with an open sinus tract communicating with a culture-positive total hip implant.
The diagnostic workup revealed discrepancies between the alpha-defensin test and clinical/microbiological findings.
Potential reasons for the false-negative alpha-defensin result are discussed.

Implications:

The findings suggest that the alpha-defensin test should be interpreted with caution and in conjunction with comprehensive clinical data.
In specific clinical situations, such as the one described, the MSIS criteria may offer superior diagnostic performance compared to the alpha-defensin test.
This case underscores the importance of considering multiple diagnostic modalities for periprosthetic hip infections.