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Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections
Lizzy Weigelt1, Andreas Plate2, Laura Stadler2
1Department of Orthopedics Surgery , University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland. lizzy.weigelt@balgrist.ch.
Purpose:
Periprosthetic joint infections (PJIs) remain a challenging complication after shoulder arthroplasty. The antimicrobial peptide α-defensin has been proposed as a new synovial fluid biomarker in diagnosing PJIs. To date, only little data are available on the diagnostic accuracy of α-defensin in shoulder PJIs; thus, we aimed to evaluate its diagnostic value in a cohort of patients with a suspected shoulder PJI.
Methods:
Between June 2016 and June 2018, we prospectively enrolled patients with a diagnostic shoulder aspiration due to painful shoulder arthroplasty or planned revision surgery. PJI diagnostics were performed according to the Musculoskeletal Infection Society (MSIS) criteria. All patients with an antibiotic therapy within two weeks before enrollment, insufficient amount of synovial aspirate, or bloody aspiration were excluded. α-Defensin was measured in the synovial fluid using the α-defensin lateral flow (ADLF) test (Synovasure®).
Results:
Out of 60 patients, we could include 29 (59% female) patients with a mean age of 70 (range, 50-92) years. A shoulder PJI was detected in five cases (Staphylococcus aureus, n = 2; Staphylococcus epidermidis, n = 2; Cutibacterium acnes, n = 1). The ADLF test was positive in seven out of 29 cases. According to the MSIS criteria, the ADLF test was false-negative in two patients and false-positive in four patients, resulting in sensitivity, specificity, and positive and negative predictive value of 60%, 83%, 43%, and 91%, respectively. The overall accuracy was 79%.
Conclusion:
The ALDF test does not appear to be useful in predicting shoulder PJIs but may be used as an additional diagnostic factor in rejecting these infections.
Insights
The alpha-defensin lateral flow (ADLF) test shows low accuracy for diagnosing shoulder periprosthetic joint infections (PJIs). While not ideal for predicting PJIs, it may help rule out infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomarker Research
Background:
- Periprosthetic joint infections (PJIs) are a significant complication following shoulder arthroplasty.
- Accurate diagnosis of shoulder PJIs is crucial for effective treatment and patient outcomes.
- Alpha-defensin has emerged as a potential synovial fluid biomarker for PJI diagnosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the alpha-defensin lateral flow (ADLF) test for shoulder PJIs.
- To assess the sensitivity, specificity, and predictive values of the ADLF test in a clinical cohort.
Main Methods:
- Prospective enrollment of patients undergoing shoulder aspiration due to suspected PJI.
- PJI diagnosis based on established Musculoskeletal Infection Society (MSIS) criteria.
- Measurement of synovial fluid alpha-defensin using the ADLF test (Synovasure®).
Main Results:
- Five cases of shoulder PJI were identified among 29 included patients.
- The ADLF test demonstrated a sensitivity of 60% and specificity of 83%.
- Positive and negative predictive values were 43% and 91%, respectively, with an overall accuracy of 79%.
Conclusions:
- The ADLF test exhibits limited utility in predicting shoulder PJIs.
- The test may serve as an adjunct diagnostic tool to help exclude shoulder PJIs.
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