Clinical Evaluation of Synovial Alpha Defensin and Synovial C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection

• DOI: 10.2106/jbjs.17.00556
• Publication Date: 2018-07-19T20:21:19Z
• Authors: William Z. Stone; Chancellor F. Gray; Hari K. Parvataneni; Mamun Al-Rashid; Richard G. Vlasak; MaryBeth Horodyski; Hernan A. Prieto
• Keywords: Adult; Aged, 80 and over; Male; 0301 basic medicine; Arthritis, Infectious; alpha-Defensins; Prosthesis-Related Infections; Middle Aged; Sensitivity and Specificity; 3. Good health; 03 medical and health sciences; C-Reactive Protein; Synovial Fluid; Humans; Female; Biomarkers; Aged

Diagnosing periprosthetic joint infection after total arthroplasty is often challenging. The alpha defensin test has been recently reported as a promising diagnostic for infection. goal of this study was to determine the accuracy testing.One hundred and eighty-three synovial fluid C-reactive protein (CRP) tests performed in 183 patients undergoing evaluation were reviewed. Results compared with Musculoskeletal Infection Society (MSIS) criteria infection.Alpha prior surgical treatment infection, 37 these who had diagnosed by MSIS having infections. Among group, sensitivity 81.1% (95% confidence interval [CI], 64.8% 92.0%) specificity 95.9% CI, 91.3% 98.5%). There 6 false-positive results, 4 which associated metallosis. 7 false negatives, all either draining sinuses (n = 3) or low-virulence organisms 4). A combined analysis CRP positive result represented 28). calculated be 73.0% 55.9% 86.2%) 99.3% 96.2% 99.9%). An additional where 64). 91.9% 78.1% 98.3%) 79.5% 72.0% 85.7%).Alpha combination demonstrates very high diagnosing but may yield results presence metallosis false-negative organisms. When both are positive, there infection.Diagnostic Level III. See Instructions Authors complete description levels evidence.