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Grünwald L, Schmidutz F, Döttger P, Erne F, Schreiner AJ, Hemmann P. Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2663-2668. [PMID: 37582980 PMCID: PMC10602937 DOI: 10.1007/s00264-023-05914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Periprosthetic joint infection (PJI) is a rare but serious complication of total joint arthroplasty (TJA). An accurate diagnosis of PJI preoperatively does not exist. Alpha-defensin (AD) is a proven and common indicator. The diagnostic marker of leukocyte esterase (LE) promises some advantages: feasibility, availability, and fast result reporting. The aim of this study was the evaluation of the predictive quality and correlation between both diagnostic tools in the diagnosis of PJI. METHODS A prospective study was conducted between April 2018 and August 2022. All patients with suspicion of PJI on hip and knee joint were included and underwent a routine and standardized joint punction. For laboratory diagnostics of AD, the synovial liquid was analyzed by ELISA. The sample was additionally applied to a LE test strip (Combur 10 Test, Roche Diagnostics, Mannheim, Germany). RESULTS A total of 249 patients were examined (mean age 67.12 ± 11.89; gender distribution man/woman 139 (55.8%)/110(44.2%), hip/knee 71(28.5%)/178 (71.5%). According to EBJIS criteria, PJI was diagnosed in 54 (21.7%) patients. AD showed excellent results with an AUC of 0.930 (sensitivity/specificity 0.870/0.990). LE yielded very good results with an AUC of 0.820 (sensitivity/specificity 0.722/0.918). Both parameters showed a strong positive correlation. CONCLUSION LE is a rapidly available alternative in PJI diagnostics. The simultaneous determination of both markers may enhance diagnostic reliability. A routine usage may shorten the time from diagnosis to treatment of PJI.
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Affiliation(s)
- Leonard Grünwald
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Florian Schmidutz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
- Orthozentrum Rosenheim, Äußere Münchener Str. 94, 83026, Rosenheim, Germany
| | - Philipp Döttger
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Felix Erne
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany.
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany.
| | - Anna Janine Schreiner
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany
| | - Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
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Solarino G, Bizzoca D, Moretti L, Vicenti G, Piazzolla A, Moretti B. What's New in the Diagnosis of Periprosthetic Joint Infections: Focus on Synovial Fluid Biomarkers. Trop Med Infect Dis 2022; 7:355. [PMID: 36355897 PMCID: PMC9692966 DOI: 10.3390/tropicalmed7110355] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 08/10/2023] Open
Abstract
Periprosthetic joint infections are some of the leading causes of revision prosthetic surgery, accounting for 25% of failed total knee replacements and 15% of failed total hip replacements. The search for a biomarker that, together with clinical and radiological findings, could improve the management of such patients is currently a significant challenge for orthopaedic surgeons. Synovial fluid is a viscous and mucinous substance produced by the synovium, a specialized connective tissue that lines diarthrodial joints. Synovial fluid is an ultrafiltrate of plasma but also contains proteins secreted from the surrounding tissues, including the articular cartilage and synovium. Therefore, synovial fluid represents a source of disease-related proteins that could be used as potential biomarkers in several articular diseases. Based on these findings, the study of synovial fluid has been gaining increasing importance in recent years. This review aims to assess the accuracy and the limitations of the most promising synovial fluid biomarkers-i.e., Alpha-Defensin, Leukocyte Esterase, C-Reactive Protein, Interleukin-6, Calprotectin, Presepsin and Neopterin-in the diagnosis of PJI. Special attention will be given to emerging synovial biomarkers, which could soon be important in diagnosing PJIs.
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Affiliation(s)
- Giuseppe Solarino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”-AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”-AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
- AOU Consorziale Policlinico di Bari, UOSD Spinal Surgery and Scoliosis Deformity Centre, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Lorenzo Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”-AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Giovanni Vicenti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”-AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Andrea Piazzolla
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”-AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
- AOU Consorziale Policlinico di Bari, UOSD Spinal Surgery and Scoliosis Deformity Centre, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Biagio Moretti
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic and Trauma Unit, University of Bari “Aldo Moro”-AOU Consorziale Policlinico di Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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