ArticleArthroplasty (London, England)2025
Alpha defensin immunoassay is more effective for ruling out rather than diagnosing periprosthetic joint infection (PJI): a prospective cohort study.
Article in Arthroplasty (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
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Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Bacteriophages in Hip and Knee Periprosthetic Joint Infections: A Promising Tool in the Era of Antibiotic Resistance.Medical sciences (Basel, Switzerland) · 2025Pooled it
- Key Inflammatory Pathways, Biomarkers, and Targeted Management Strategies in Primary Total Joint Arthroplasty: A Narrative Review.Medicina (Kaunas, Lithuania) · 2026Review
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Authors and funding
7 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundAccurate and timely diagnosis of periprosthetic joint infection (PJI) is of utmost importance. Although synovial alpha-defensin has shown potential as a biomarker, recent studies have questioned its additional benefit over traditional synovial biomarkers and advised against its routine use. The primary objective is to evaluate the diagnostic accuracy of the alpha-defensin immunoassay in PJI. Secondary objectives include comparing its diagnostic accuracy against traditional biomarkers and assessing our results in the context of existing research to provide a solid perspective on its clinical utility.
methodsThis is a prospective cohort study. Synovial samples were obtained at the time of revision arthroplasty or from painful arthroplasties. A complete laboratory workup was performed, including CBC, ESR, CRP, WBCs count. Synovial samples were analyzed for leucocytic count, PMN percentage, leucocyte esterase, and alpha-defensin immunoassay. Culture and sensitivity, and histopathology were also done. Patients who met the inclusion criteria were classified into septic and aseptic according to MSIS criteria.
resultsNinety joints met our inclusion criteria. Alpha-defensin immunoassay was positive in 36 joints and negative in 54 joints, with 1 false positive and 3 false negatives, resulting in a sensitivity of 92.11% (95% CI, 78.62-98.34%), a specificity of 98.08% (95% CI, 89.74-99.95%), positive predictive value (PPV) of 49.43% (95% CI, 12.28-87.22%), negative predictive value (NPV) of 99.84% (95% CI, 99.52-99.94%) and diagnostic accuracy of 97.96% (95% CI, 92.48-99.78%). The optimal cutoff was 9.2, and the area under the curve (AUC) was 0.945.
conclusionsWhile the alpha defensin immunoassay is not recommended to be used routinely as a screening method for PJI, its high specificity and NPV make it a valuable addition to traditional blood and synovial parameters in the diagnosis of complex hip and knee PJI, particularly for ruling out infection.
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