ArticleBMC musculoskeletal disorders2023
It can be unnecessary to combine common synovial fluid analysis and alpha-defensin tests for periprosthetic joint infection diagnosis.
Article in BMC musculoskeletal disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Is synovial calprotectin lateral flow test a reliable intraoperative biomarker for periprosthetic joint infection? A systematic review and meta-analysis.Archives of orthopaedic and trauma surgery · 2026Pooled it
- Synovial fluid specific gravity as an inexpensive point-of-care test for diagnosing hip and knee periprosthetic joint infection.Journal of bone and joint infection · 2026Article
- Alpha defensin immunoassay is more effective for ruling out rather than diagnosing periprosthetic joint infection (PJI): a prospective cohort study.Arthroplasty (London, England) · 2025Article
- Significant differences in the rate of periprosthetic joint infections in revision hip and knee arthroplasty depending on the applied definition.Archives of orthopaedic and trauma 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
- Differential synovial fluid white blood cell count for the diagnosis of chronic peri-prosthetic joint infection - a systematic review and meta-analysis.Journal of bone and joint infection · 2025Article
- Analysis of Serum and Synovial Inflammatory Markers in Periprosthetic Joint Infections: A Narrative Review.Cureus · 2024Review
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundPeriprosthetic joint infection is a serious complication after total joint arthroplasty. Despite that alpha-defensin was used as diagnostic test in the 2018 ICM (international consensus meeting) criteria, its position in the PJI diagnostic pipeline was controversial. Therefore, we performed a retrospective pilot study to identify whether synovial fluid alpha-defensin test was necessary when corresponding synovial fluid analysis (WBC count, PMN% and LE tests) was performed.
methodsBetween May 2015 and October 2018, a total of 90 suspected PJI patients who underwent revisions after TJA were included in this study. Based on the 2018 ICM criteria, the interobserver agreements between preoperative diagnostic results and postoperative diagnostic results and the interobserver reliability between preoperative diagnostic results and postoperative diagnostic results with or without synovial fluid alpha-defensin tests were calculated. After that, the ROC analysis, and the direct cost-effectiveness of adding alpha-defensin was performed.
resultsThere were 48,16 and 26 patients in the PJI group, inconclusive group and non-PJI group, respectively. Adding the alpha-defensin tests into 2018 ICM criteria can't change the preoperative diagnostic results, postoperative diagnostic results, and the concordance between preoperative and postoperative diagnostic results. Moreover, the Risk-benefit Ratio is over 90 per changed decision and the direct cost-effectiveness of alpha-defensin was more than $8370($93*90) per case.
conclusionsAlpha-defensin assay exhibit high sensitivity and specificity for PJI detection as a standalone test based on the 2018 ICM criteria. However, the additional order of Alpha-defensin can't offer additional evidence for PJI diagnosis when corresponding synovial fluid analysis was performed (synovial fluid WBC count, PMN% and LE strip tests). EVIDENCE LEVEL: Level II, Diagnostic study.
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