Artikel
Diagnostic Accuracy of Alpha-Defensin Enzyme-linked Immunosorbent Assay in the Clinical Evaluation of Painful Hip and Knee Arthroplasty with Possible Periprosthetic Joint Infection: A Prospective Study of 268 Cases
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Veröffentlicht: | 22. Oktober 2019 |
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Gliederung
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Objectives: To evaluate the diagnostic accuracy of the synovial alpha-defensin ELISA for the diagnosis of periprosthetic joint infection (PJI) in the routine clinical work-up of symptomatic total hip and knee arthroplasties before revision surgery.
Methods: Inclusion criteria for this prospective cohort study were acute or chronic symptoms of the index joint without specific exclusion criteria. Synovial fluid aspirates of n=268 patients were analyzed and semi-quantitative laboratory alpha-defensin ELISA was performed. Final diagnosis of PJI was established by examination of samples obtained during revision surgery.
Results and conclusion: Sensitivity and specificity of the alpha-defensin ELISA for PJI were 78.2% (95% CI: 67.3-88.6%) and 96.2% (95% CI: 93.4-98.6%). Positive and negative predictive value were 84.3% (95% CI: 72.5-94.1) and 94.5% (95% CI: 91.7-97.4). The test remained false negative in 22% of septic revisions, all of which occurred in either late-chronic or early-postoperative but not in late acute-hematogenous PJI.
The routine use of synovial fluid alpha-defensin laboratory ELISA in the preoperative evaluation of symptomatic hip and knee arthroplasties still leaves a diagnostic gap. There remains a need for tests with a higher sensitivity, in particular for the diagnosis of late-chronic and early-postoperative PJI.