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Synovial fluid α-defensin in the diagnosis of periprosthetic joint infection: the lateral flow test is an effective

Xuequan Han1, Kai Xie1, Xu Jiang1

  • 1Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, China.

Journal of Orthopaedic Surgery and Research
|August 29, 2019
PubMed
Abstract

Insights

Synovial fluid alpha-defensin (α-defensin) is a key biomarker for diagnosing periprosthetic joint infection (PJI). Laboratory-based immunoassays show high accuracy, while lateral flow tests offer a useful, albeit less sensitive, intraoperative option for PJI detection.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Biomarker Discovery

Background:

  • Synovial fluid alpha-defensin (α-defensin) serves as a critical biomarker for diagnosing periprosthetic joint infection (PJI).
  • Existing diagnostic evaluations for α-defensin in PJI show inconsistent results, particularly concerning different testing methodologies.
  • Accurate and reliable diagnostic tools are essential for timely PJI management.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of laboratory-based immunoassay for α-defensin in detecting hip and knee PJI.
  • To assess the diagnostic performance of lateral flow testing for α-defensin in identifying PJI.
  • To compare the effectiveness of different α-defensin testing methods for PJI diagnosis.

Main Methods:

  • Systematic literature search of MEDLINE and EMBASE databases up to September 2018.
  • Inclusion of 19 studies evaluating the diagnostic accuracy of α-defensin for PJI.
  • Calculation of pooled sensitivity, specificity, AUC, PLR, NLR, and DOR for both laboratory-based immunoassay and lateral flow tests.

Main Results:

  • Laboratory-based immunoassays demonstrated high pooled diagnostic accuracy: sensitivity 0.96, specificity 0.97, AUC 0.99.
  • Lateral flow tests showed good pooled accuracy: sensitivity 0.86, specificity 0.96, AUC 0.95.
  • Laboratory-based immunoassays yielded significantly higher diagnostic odds ratios (811) compared to lateral flow tests (148).

Conclusions:

  • Laboratory-based immunoassay of α-defensin is a highly accurate method for diagnosing hip and knee PJI.
  • Lateral flow testing for α-defensin, while less sensitive, remains a valuable tool for intraoperative PJI detection.
  • The choice of testing method impacts diagnostic performance for PJI.
Keywords:
ArthroplastyBiomarkerDiagnosisPeriprosthetic joint infectionα-Defensin

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