TY - JOUR
T1 - Synovial fluid α defensin has comparable accuracy to synovial fluid white blood cell count and polymorphonuclear percentage for periprosthetic joint infection diagnosis
AU - Ivy, M. I.
AU - Sharma, K.
AU - Greenwood-Quaintance, K. E.
AU - Tande, A. J.
AU - Osmon, D. R.
AU - Berbari, E. F.
AU - Mandrekar, J.
AU - Beauchamp, C. P.
AU - Hanssen, A. D.
AU - Abdel, M. P.
AU - Lewallen, D. G.
AU - Perry, K.
AU - Block, D. R.
AU - Snyder, M. R.
AU - Patel, R.
N1 - Funding Information:
AD testing was supported by CD Diagnostics, now part of Zimmer Biomet. Dr. Patel is supported by the National Institutes of Health (award number
Funding Information:
M. P. Abdel is on the American Academy of Orthopedic Surgeons (AAOS) Board of Directors, and reports royalties from Stryker, unrelated to this study. R. Patel reports grants from Merck, ContraFect, TenNor Therapeutics Limited and Shionogi, and consultancy payments from Curetis, Specific Technologies, Next Gen Diagnostics, PathoQuest, Selux Diagnostics, 1928 Diagnostics, PhAST, and Qvella (monies are paid to Mayo Clinic). R. Patel is also a consultant for Netflix, and has a patent on Bordetella pertussis/parapertussis PCR issued, a patent with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued. R. Patel also receives an editor’s stipend from IDSA, and honoraria from the NBME, Up-to-Date and the Infectious Diseases Board Review Course. D. G. Lewallen reports board membership on the American Joint Replacement Registry and Orthopaedic Research and Education Foundation, consultancy payments from Zimmer Biomet, a grant from NIAMS (P30AR76312), royalties from Mako/Stryker, stock/stock options from Acuitive Technologies and Ketai Medical Devices, and research support from Corin USA, all unrelated to this study. E. F. Berbari reports consultancy fee/honorarium from UTD under $5,000 per year, unrelated to this study. A. D. Hanssen and M. P. Abdel report royalties from Stryker, unrelated to this study. K. Perry reports consultancy payments from Depuy Johnson and Johnson, unrelated to this study.
Funding Information:
AD testing was supported by CD Diagnostics, now part of Zimmer Biomet. Dr. Patel is supported by the National Institutes of Health (award number R01 AR056647). The author or one or more of the authors have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. In addition, benefits have been or will be directed to a research fund, foundation, educational institution, or other non- profit organization with which one or more of the authors are associated.
Publisher Copyright:
© 2021 The British Editorial Society of Bone & Joint Surgery doi:10.1302/0301-620X.103B6. BJJ-2020-1741.R1 $2.00
PY - 2021
Y1 - 2021
N2 - Aims the aim of this study was to determine the diagnostic accuracy of α defensin (AD) lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) tests for periprosthetic joint infection (PJI) in comparison to conventional synovial white blood cell (WBC) count and polymorphonuclear neutrophil percentage (PMN%) analysis. Methods Patients undergoing joint aspiration for evaluation of pain after total knee arthroplasty (TKA) or total hip arthroplasty (THA) were considered for inclusion. Synovial fluids from 99 patients (25 THA and 74 TKA) were analyzed by WBC count and PMN% analysis, AD LFA, and AD ELISA. WBC and PMN% cutoffs of ≥ 1,700 cells/mm3 and ≥ 65% for TKA and ≥ 3,000 cells/mm3 and ≥ 80% for THA were used, respectively. A panel of three physicians, all with expertise in orthopaedic infections and who were blinded to the results of AD tests, independently reviewed patient data to diagnose subjects as with or without PJI. Consensus PJI classification was used as the reference standard to evaluate test performances. Results were compared using McNemar's test and area under the receiver operating characteristic curve (AUC) analysis. results Expert consensus classified 18 arthroplasies as having failed due to PJI and 81 due to aseptic failure. Using these classifications, the calculated sensitivity and specificity of AD LFA was 83.3% (95% confidence interval (CI) 58.6 to 96.4) and 93.8% (95% CI 86.2 to 98.0), respectively. Sensitivity and specificity of AD ELISA was 83.3% (95% CI 58.6 to 96.4) and 96.3% (95% CI 89.6 to 99.2), respectively. There was no statistically significant difference between sensitivity (p = 1.000) or specificity (p = 0.157) of the two AD assays. AUC for AD LFA was 0.891. In comparison, AUC for synovial WBC count, PMN%, and the combination of the two values was 0.821 (sensitivity p = 1.000, specificity p < 0.001), 0.886 (sensitivity p = 0.317, specificity p = 0.011), and 0.926 (sensitivity p = 0.317, specificity p = 0.317), respectively. Conclusion The diagnostic accuracy of synovial AD for PJI diagnosis is comparable and not statistically superior to that of synovial WBC count plus PMN% combined.
AB - Aims the aim of this study was to determine the diagnostic accuracy of α defensin (AD) lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) tests for periprosthetic joint infection (PJI) in comparison to conventional synovial white blood cell (WBC) count and polymorphonuclear neutrophil percentage (PMN%) analysis. Methods Patients undergoing joint aspiration for evaluation of pain after total knee arthroplasty (TKA) or total hip arthroplasty (THA) were considered for inclusion. Synovial fluids from 99 patients (25 THA and 74 TKA) were analyzed by WBC count and PMN% analysis, AD LFA, and AD ELISA. WBC and PMN% cutoffs of ≥ 1,700 cells/mm3 and ≥ 65% for TKA and ≥ 3,000 cells/mm3 and ≥ 80% for THA were used, respectively. A panel of three physicians, all with expertise in orthopaedic infections and who were blinded to the results of AD tests, independently reviewed patient data to diagnose subjects as with or without PJI. Consensus PJI classification was used as the reference standard to evaluate test performances. Results were compared using McNemar's test and area under the receiver operating characteristic curve (AUC) analysis. results Expert consensus classified 18 arthroplasies as having failed due to PJI and 81 due to aseptic failure. Using these classifications, the calculated sensitivity and specificity of AD LFA was 83.3% (95% confidence interval (CI) 58.6 to 96.4) and 93.8% (95% CI 86.2 to 98.0), respectively. Sensitivity and specificity of AD ELISA was 83.3% (95% CI 58.6 to 96.4) and 96.3% (95% CI 89.6 to 99.2), respectively. There was no statistically significant difference between sensitivity (p = 1.000) or specificity (p = 0.157) of the two AD assays. AUC for AD LFA was 0.891. In comparison, AUC for synovial WBC count, PMN%, and the combination of the two values was 0.821 (sensitivity p = 1.000, specificity p < 0.001), 0.886 (sensitivity p = 0.317, specificity p = 0.011), and 0.926 (sensitivity p = 0.317, specificity p = 0.317), respectively. Conclusion The diagnostic accuracy of synovial AD for PJI diagnosis is comparable and not statistically superior to that of synovial WBC count plus PMN% combined.
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U2 - 10.1302/0301-620X.103B6.BJJ-2020-1741.R1
DO - 10.1302/0301-620X.103B6.BJJ-2020-1741.R1
M3 - Article
C2 - 34058872
AN - SCOPUS:85107323579
SN - 2049-4394
VL - 103 B
SP - 1119
EP - 1126
JO - Bone and Joint Journal
JF - Bone and Joint Journal
IS - 6
ER -