Synovial fluid neutrophil extracellular traps could improve the diagnosis of periprosthetic joint infection

Area of Science:

• Orthopedics
• Infectious Diseases
• Biomarker Discovery

Background:

• Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
• Accurate and timely diagnosis of PJI is crucial for effective treatment and patient outcomes.
• Current diagnostic methods have limitations, particularly in culture-negative or pre-treated cases.

Purpose of the Study:

• To evaluate the diagnostic performance of synovial fluid neutrophil extracellular traps (SF-NETs) for PJI.
• To compare the efficacy of SF-NETs with conventional diagnostic markers such as microbial culture, ESR, CRP, WBC count, and PMN percentage.
• To determine the utility of SF-NETs in improving PJI diagnosis in specific patient subgroups.

Main Methods:

• A single-center study enrolled patients with suspected PJI and controls with aseptic failure (AF) between January 2013 and December 2021.
• Synovial fluid was collected for microbial culture, white blood cell (WBC) count, polymorphonuclear neutrophil percentage (PMN%), and SF-NET detection.
• Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy (Area Under the Curve - AUC) of SF-NETs and other markers.

Main Results:

• SF-NET levels were significantly higher in the PJI group compared to the AF group.
• SF-NET demonstrated high diagnostic accuracy with an AUC of 0.971, sensitivity of 93.48%, and specificity of 96.43%.
• SF-NET improved the diagnosis of culture-negative PJI, PJI in patients with preoperative antibiotic treatment, and fungal PJI.

Conclusions:

• SF-NET is a novel and highly effective synovial fluid biomarker for diagnosing PJI.
• SF-NET offers superior diagnostic performance compared to traditional methods, enhancing PJI detection rates.
• This biomarker holds significant potential to greatly improve the diagnostic process for PJI.