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01-01-2020 | Joint Infection | Original Paper

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

Authors: Max Ettinger, Peter Savov, Tilman Calliess, Henning Windhagen, Ralf Lichtinghagen, Alexander Lukasz, Mohamed Omar

Published in: International Orthopaedics | Issue 1/2020

Abstract

Background

The 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.

Methods

Inclusion 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).

Results

The 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.

Conclusions

Alpha 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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Title: 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
Authors: Max Ettinger
Peter Savov
Tilman Calliess
Henning Windhagen
Ralf Lichtinghagen
Alexander Lukasz
Mohamed Omar
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Joint Infection
Biomarkers
Published in: International Orthopaedics / Issue 1/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04338-6

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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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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