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German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

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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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  • presenting/speaker Nico Maximilian Jandl - Klinik und Poliklinik für Orthopädie, UKE, Hamburg, Germany
  • Sebastian Kleiss - Klinik und Poliklinik für Orthopädie, UKE, Hamburg, Germany
  • Alexander Novo de Oliveira - Klinik und Poliklinik für Orthopädie, UKE, Hamburg, Germany
  • Wolfgang Rüther - Klinik und Poliklinik für Orthopädie, UKE, Hamburg, Germany
  • Andreas Niemeier - Klinik und Poliklinik für Orthopädie, UKE, Hamburg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAB17-61

doi: 10.3205/19dkou057, urn:nbn:de:0183-19dkou0571

Published: October 22, 2019

© 2019 Jandl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.