ArticleJournal of orthopaedic case reports2026
Diagnostic Accuracy of Synovial Alpha-Defensin and Histopathology for Periprosthetic Joint Infection: A Validation Study.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Periprosthetic joint infection (PJI) remains one of the most serious complications following total hip and knee arthroplasty, often leading to repeated surgeries, prolonged hospitalization, and poor functional outcomes. Accurate and timely diagnosis is challenging due to variable clinical presentation and the limitations of conventional diagnostic tests. Synovial alpha-defensin has emerged as a promising biomarker for PJI, while histopathological examination of periprosthetic tissue continues to be an important intraoperative diagnostic modality. This study aimed to validate and compare the diagnostic accuracy of synovial alpha-defensin and histopathology in detecting PJI. Objectives: The objective of the study was to evaluate the diagnostic performance of synovial alpha-defensin and histopathological examination of periprosthetic tissue individually and in combination for the diagnosis of PJI. Methods: This prospective diagnostic validation study included 50 patients undergoing revision total hip or knee arthroplasty at a tertiary care center. Preoperative synovial fluid samples were analyzed for alpha-defensin. Intraoperatively, multiple periprosthetic tissue samples were obtained for histopathological examination. The final diagnosis of PJI was established using standardized reference criteria incorporating clinical, laboratory, microbiological, and histological findings. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated for each modality. Results: Of the 50 patients, 22 (44%) were diagnosed with PJI. Synovial alpha-defensin demonstrated a sensitivity of 90.9% and specificity of 92.9%, with an overall diagnostic accuracy of 92%. Histopathology showed a sensitivity of 81.8% and specificity of 85.7%, with an accuracy of 84%. Combined interpretation of both tests improved sensitivity to 95.5% and specificity to 96.4%, yielding the highest diagnostic accuracy (96%). Conclusion: Synovial alpha-defensin is a highly reliable diagnostic marker for PJI and outperforms histopathology when used alone. However, the combined use of synovial alpha-defensin and histopathological examination provides superior diagnostic accuracy, supporting their complementary role in contemporary PJI diagnostic algorithms.
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