Top

International Orthopaedics

Published in:

Open Access 16-08-2023 | Joint Infection | Original Paper

Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study

Authors: Leonard Grünwald, Florian Schmidutz, Philipp Döttger, Felix Erne, Anna Janine Schreiner, Philipp Hemmann

Published in: International Orthopaedics | Issue 11/2023

Abstract

Purpose

Periprosthetic joint infection (PJI) is a rare but serious complication of total joint arthroplasty (TJA). An accurate diagnosis of PJI preoperatively does not exist. Alpha-defensin (AD) is a proven and common indicator. The diagnostic marker of leukocyte esterase (LE) promises some advantages: feasibility, availability, and fast result reporting. The aim of this study was the evaluation of the predictive quality and correlation between both diagnostic tools in the diagnosis of PJI.

Methods

A prospective study was conducted between April 2018 and August 2022. All patients with suspicion of PJI on hip and knee joint were included and underwent a routine and standardized joint punction. For laboratory diagnostics of AD, the synovial liquid was analyzed by ELISA. The sample was additionally applied to a LE test strip (Combur 10 Test, Roche Diagnostics, Mannheim, Germany).

Results

A total of 249 patients were examined (mean age 67.12 ± 11.89; gender distribution man/woman 139 (55.8%)/110(44.2%), hip/knee 71(28.5%)/178 (71.5%). According to EBJIS criteria, PJI was diagnosed in 54 (21.7%) patients. AD showed excellent results with an AUC of 0.930 (sensitivity/specificity 0.870/0.990). LE yielded very good results with an AUC of 0.820 (sensitivity/specificity 0.722/0.918). Both parameters showed a strong positive correlation.

Conclusion

LE is a rapidly available alternative in PJI diagnostics. The simultaneous determination of both markers may enhance diagnostic reliability. A routine usage may shorten the time from diagnosis to treatment of PJI.

Rupp M, Lau E, Kurtz SM, Alt V (2020) Projections of primary TKA and THA in Germany from 2016 through 2040. Clin Orthop Relat Res 478:1622–1633. https://doi.org/10.1097/CORR.0000000000001214CrossRefPubMedPubMedCentral

Singh JA, Yu S, Chen L, Cleveland JD (2019) Rates of total joint replacement in the United States: future projections to 2020–2040 using the national inpatient sample. J Rheumatol 46:1134–1140. https://doi.org/10.3899/jrheum.170990CrossRefPubMed

Walter N, Rupp M, Hierl K, Koch M, Kerschbaum M, Worlicek M, Alt V (2021) Long-term patient-related quality of life after knee periprosthetic joint infection. J Clin Med 10(5):907. https://doi.org/10.3390/jcm10050907CrossRefPubMedPubMedCentral

Li C, Renz N, Trampuz A (2018) Management of Periprosthetic Joint Infection. Hip Pelvis 30:138–146. https://doi.org/10.5371/hp.2018.30.3.138CrossRefPubMedPubMedCentral

Klug A, Gramlich Y, Rudert M, Drees P, Hoffmann R, Weissenberger M, Kutzner KP (2021) The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years. Knee Surg Sports Traumatol Arthrosc 29:3287–3298. https://doi.org/10.1007/s00167-020-06154-7CrossRefPubMed

Li C, Ojeda-Thies C, Xu C, Trampuz A (2020) Meta-analysis in periprosthetic joint infection: a global bibliometric analysis. J Orthop Surg Res 15:251. https://doi.org/10.1186/s13018-020-01757-9CrossRefPubMedPubMedCentral

Li B, Chen F, Liu Y, Xu G (2017) Synovial fluid alpha-defensin as a biomarker for peri-prosthetic joint infection: a systematic review and meta-analysis. Surg Infect (Larchmt) 18:702–710. https://doi.org/10.1089/sur.2017.006CrossRefPubMed

Lee YS, Koo KH, Kim HJ, Tian S, Kim TY, Maltenfort MG, Chen AF (2017) Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 99:2077–2084. https://doi.org/10.2106/JBJS.17.00123CrossRefPubMed

Goud A, Nutzinger D, van der Bij A, Jenniskens K, Groenewold J, de Gast A, Bekkers JEJ (2022) Synovial-based tests outperform serum markers to rule out infection in total knee arthroplasty and total hip arthroplasty: a systematic review and meta-analysis. J Arthroplasty 37:802-808 e805. https://doi.org/10.1016/j.arth.2021.12.020CrossRefPubMed

10.

Busch A, Jager M, Engler H, Wasssenaar D, Bielefeld C, Wegner A (2022) Diagnostic accuracy of synovial neopterin, tnf-alpha and presepsin in periprosthetic joint infection: a prospective study. Z Orthop Unfall 160:299–306. https://doi.org/10.1055/a-1303-5105CrossRefPubMed

11.

Shohat N, Bauer T, Buttaro M, Budhiparama N, Cashman J, Della Valle CJ, Drago L, Gehrke T, Marcelino Gomes LS, Goswami K, Hailer NP, Han SB, Higuera CA, Inaba Y, Jenny JY, Kjaersgaard-Andersen P, Lee M, Llinas A, Malizos K, Mont MA, Jones RM, Parvizi J, Peel T, Rivero-Boschert S, Segreti J, Soriano A, Sousa R, Spangehl M, Tan TL, Tikhilov R, Tuncay I, Winkler H, Witso E, Wouthuyzen-Bakker M, Young S, Zhang X, Zhou Y, Zimmerli W (2019) Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints?: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 34:S325–S327. https://doi.org/10.1016/j.arth.2018.09.045CrossRefPubMed

12.

Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N (2018) The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty 33:1309-1314 e1302. https://doi.org/10.1016/j.arth.2018.02.078CrossRefPubMed

13.

Yu BZ, Li R, Fu J, Chai W, Hao LB, Chen JY (2021) Leukocyte esterase test and alpha-defensin test have similar accuracy for the diagnosis of periprosthetic joint infection. Int Orthop 45:1677–1682. https://doi.org/10.1007/s00264-020-04903-4CrossRefPubMed

14.

De Vecchi E, Romano CL, De Grandi R, Cappelletti L, Villa F, Drago L (2018) Alpha defensin, leukocyte esterase, C-reactive protein, and leukocyte count in synovial fluid for pre-operative diagnosis of periprosthetic infection. Int J Immunopathol Pharmacol 32:2058738418806072. https://doi.org/10.1177/2058738418806072CrossRefPubMedPubMedCentral

15.

McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, Clauss M, Higuera CA, Trebše R (2021) The EBJIS definition of periprosthetic joint infection. Bone Joint J 103-b:18–25. https://doi.org/10.1302/0301-620x.103b1.Bjj-2020-1381.R1CrossRefPubMedPubMedCentral

16.

Sigmund IK, Yermak K, Perka C, Trampuz A, Renz N (2018) Is the enzyme-linked immunosorbent assay more accurate than the lateral flow alpha defensin test for diagnosing periprosthetic joint infection? Clin Orthop Relat Res 476:1645–1654. https://doi.org/10.1097/CORR.0000000000000336CrossRefPubMedPubMedCentral

17.

Sharma K, Ivy M, Block DR, Abdel MP, Hanssen AD, Beauchamp C, Perry KI, Rosemark CL, Greenwood-Quaintance KE, Mandrekar J, Patel R (2020) Comparative analysis of 23 synovial fluid biomarkers for hip and knee periprosthetic joint infection detection. J Orthop Res 38:2664–2674. https://doi.org/10.1002/jor.24766CrossRefPubMed

18.

Kuo FC, Lin PC, Yen SH, Tan TL, Wu CT, Wang JW (2022) Which minor criteria is the most accurate predictor for the diagnosis of hip and knee periprosthetic joint infection in the Asian population? J Arthroplasty 37:2076–2081. https://doi.org/10.1016/j.arth.2022.05.002CrossRefPubMed

19.

Levent A, Neufeld ME, Piakong P, Lausmann C, Gehrke T, Citak M (2021) Which international consensus meeting preoperative minor criteria is the most accurate marker for the diagnosis of periprosthetic joint infection in hip and knee arthroplasty? J Arthroplasty 36:3728–3733. https://doi.org/10.1016/j.arth.2021.06.030CrossRefPubMed

20.

Tang H, Xu J, Yuan W, Wang Y, Yue B, Qu X (2022) Reliable diagnostic tests and thresholds for preoperative diagnosis of non-inflammatory arthritis periprosthetic joint infection: a meta-analysis and systematic review. Orthop Surg 14:2822–2836. https://doi.org/10.1111/os.13500CrossRefPubMedPubMedCentral

21.

Li R, Lu Q, Zhou YG, Chai W, Lu SB, Chen JY (2018) Centrifugation may change the results of leukocyte esterase strip testing in the diagnosis of periprosthetic joint infection. J Arthroplasty 33:2981–2985. https://doi.org/10.1016/j.arth.2018.04.015CrossRefPubMed

22.

Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Booth RE Jr, Parvizi J (2015) The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip. Clin Orthop Relat Res 473:198–203. https://doi.org/10.1007/s11999-014-3722-7CrossRefPubMed

Title: Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study
Authors: Leonard Grünwald
Florian Schmidutz
Philipp Döttger
Felix Erne
Anna Janine Schreiner
Philipp Hemmann
Publication date: 16-08-2023
Publisher: Springer Berlin Heidelberg
Keyword: Joint Infection
Published in: International Orthopaedics / Issue 11/2023
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-023-05914-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2023

High infection control rate after systematic one-stage procedure for shoulder arthroplasty chronic infection

Letter to the editor: Early outcome measurement of the effectiveness of conventional physical therapy versus continuous passive motion in knee function following retrograde femoral nailing—a prospective randomized controlled trial

Comparative analysis of patient-reported outcomes after percutaneous endoscopic lumbar discectomy between transforaminal and interlaminar approach: a minimum two year follow-up

Modified classifications and surgical decision-making process for chronic anterior talofibular ligament injuries based on the correlation of imaging studies and arthroscopic findings

Talar coverage of the tibia plays a role in anterior ankle impingement: a retrospective cohort study

Proximal tibial osteotomy with absorbable spacer combined with fibular osteotomy has similar clinical outcomes to high tibial osteotomy in the treatment of knee osteoarthritis