ArticleInternational orthopaedics2020
Improved diagnostic accuracy with the classification tree method for diagnosing low-grade periprosthetic joint infections by quantitative measurement of synovial fluid alpha-defensin and C-reactive protein.
Article in International orthopaedics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 4 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 4 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Serum versus synovial fluid interleukin-6 for periprosthetic joint infection diagnosis: a systematic review and meta-analysis of 30 diagnostic test accuracy studies.Journal of orthopaedic surgery and research · 2022Pooled it
- Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non-Inflammatory Arthritis Periprosthetic Joint Infection: A Meta-analysis and Systematic Review.Orthopaedic surgery · 2022Pooled it
- Does the Alpha Defensin ELISA Test Perform Better Than the Alpha Defensin Lateral Flow Test for PJI Diagnosis? A Systematic Review and Meta-analysis of Prospective Studies.Clinical orthopaedics and related research · 2020Pooled it
- Candida periprosthetic infection of the hip: a systematic review of surgical treatments and clinical outcomes.International orthopaedics · 2020Pooled it
- The detection of cardiovascular biomarkers in dermal interstitial fluid - a step to real-time monitoring.Frontiers in cardiovascular medicine · 2026Review
- Correlation of Preoperative Inflammation/Immunity Markers With Postoperative Urinary Tract Infections in Elderly Hip Fracture Patients.Orthopaedic surgery · 2025Article
- Diagnostic accuracy of alpha-defensin ELISA and lateral flow assays for periprosthetic joint infection: a systematic review and meta-analysis.Journal of bone and joint infection · 2025Review
- Association between inflammation-based prognostic markers and mortality after hip replacement.Scientific reports · 2024Article
- Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition.Journal of bone and joint infection · 2023Article
- Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty.Medicina (Kaunas, Lithuania) · 2022Article
- High platelet-to-lymphocyte ratio predicts poor survival of elderly patients with hip fracture.International orthopaedics · 2021Article
- Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario.BMC musculoskeletal disorders · 2020Article
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe diagnosis of low-grade periprosthetic joint infections (PJIs) is challenging, because patients may present with unspecific symptoms, false-negative cultures, or marginally elevated values of serum biomarkers like C-reactive protein (CRP). This may lead to the unintended implantation of a revision prosthesis into an infected surgical site with a repeat risk of short-term failure. Conversely, false diagnosis of joint infection may result in multistage revision procedures, which expose the patient to unnecessary surgical procedures and inappropriate antibiotic treatment. Here, we investigated whether synovial biomarkers can preoperatively distinguish between aseptic prosthesis loosening and low-grade joint infection and the most accurate biomarker combinations.
methodsInclusion criteria for the study were indication for revision arthroplasty due to aseptic implant failure, acute high-grade infection, or (suspected) low-grade infection. We prospectively collected synovial fluid of patients undergoing revision arthroplasty for quantitative measurement of alpha defensin, CRP, interleukin (IL-6), IL-10, and lipopolysaccharide binding protein (LBP).
resultsThe classification tree method revealed alpha defensin and CRP as the most suitable biomarker combination to distinguish between aseptic loosening and low-grade joint infection. The combination of CRP > 2.0 mg/L and alpha defensin > 90.000 pg/mL correctly identified nine of 11 patients with low-grade infection.
conclusionsAlpha defensin plus CRP seems to be the most helpful combination for pre-operative discrimination of aseptic loosening vs. low-grade joint infection.
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