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Diagnosis of Periprosthetic Joint Infection Using Polymerase Chain Reaction: An Updated Systematic Review and

Yang Jun1, Liu Jianghua1

  • 1Department of Orthopedics and Traumatology, Yuxi Municipal Hospital of Traditional Chinese Medicine , Yuxi, Yunnan, China .

Surgical Infections
|June 20, 2018
PubMed
Abstract

Insights

Polymerase chain reaction (PCR) shows decreased sensitivity for diagnosing periprosthetic joint infection (PJI) compared to previous analyses. However, its high specificity remains reliable for excluding PJI, with novel biomarkers potentially offering greater diagnostic efficiency.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Diagnostic Microbiology

Background:

  • Periprosthetic joint infection (PJI) diagnosis remains challenging.
  • Previous meta-analyses show variable diagnostic efficiency for polymerase chain reaction (PCR) assays.
  • An updated meta-analysis is needed to evaluate current PCR diagnostic efficiency for PJI.

Purpose of the Study:

  • To update a meta-analysis evaluating the diagnostic efficiency of PCR for PJI.
  • To compare PCR's diagnostic performance with other synovial fluid biomarkers.

Main Methods:

  • Systematic review of studies from 2013 to May 2017.
  • Inclusion/exclusion criteria and quality assessment of 20 studies (2,526 participants).
  • Pooled sensitivity, specificity, and diagnostic odds ratio (DOR) calculation.

Main Results:

  • Pooled sensitivity was 0.76 (95% CI: 0.65-0.85) and specificity was 0.94 (95% CI: 0.92-0.95).
  • Diagnostic odds ratio (DOR) was 0.94 (95% CI: 0.92-0.96).
  • Meta-regression suggested improved sensitivity with specific genes, fresh samples, and multiple samples per patient.

Conclusions:

  • PCR sensitivity for PJI diagnosis has decreased compared to prior meta-analyses (0.86).
  • PCR maintains high specificity, proving reliable for PJI exclusion.
  • Novel biomarkers like α-defensin show higher pooled sensitivity (0.96-1.00) and may be more efficient for PJI diagnosis.
Keywords:
meta-analysispolymerase chain reactionprosthetic joint infectionsynovial fluid biomarkers

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