Top

International Orthopaedics

Published in:

01-12-2017 | Review Article

Diagnostic accuracy of alpha-defensin in periprosthetic joint infection: a systematic review and meta-analysis

Authors: Jun Yuan, Yufei Yan, Jiong Zhang, Bibo Wang, Jianmin Feng

Published in: International Orthopaedics | Issue 12/2017

Abstract

Background

Alpha-defensin, a novel biomarker, has shown great potential for the accurate diagnosis of periprosthetic joint infection (PJI) in recent years: many published studies have presented encouraging results. Nevertheless, the diagnostic accuracy of alpha-defensin is inconsistent across published studies. Moreover, the optimum value of the diagnostic threshold urgently needs to be ascertained. This meta-analysis sought to estimate the precision of alpha-defensin for the diagnosis of PJI and, where possible, to confirm the threshold.

Method

We systematically searched PubMed, Embase, Cochrane, Web of Knowledge, and ClinicalTrials.gov for relevant literature on alpha-defensin in the diagnosis of PJI (searching publications from the inception of each database until February 2017, with no language restriction). Pooled sensitivity, specificity, diagnostic odds ratios, and likelihood ratios were the indexes used for assessment, with the use of a random-effects model.

Result

Eleven of the 426 studies that evaluated the diagnostic accuracy of alpha-defensin in periprosthetic joint infection (PJI) were included in this analysis. The pooled diagnostic sensitivity of alpha-defensin for PJI was 0.96 (95% confidence interval [CI], 0.87 to 0.99) and the specificity was 0.95 (95% CI, 0.91 to 0.97). Since there was substantial heterogeneity among studies, based on the inconsistency index (I²), threshold, site of arthroplasty, study design and techniques for the alpha-defensin test, subgroup analyses were performed to estimate the impacts of these variables on heterogeneity.

Conclusion

In summary, this meta-analysis clearly lends support to the conclusion that alpha-defensin is a promising addition to the current methods for diagnosis of PJI.

Available only for authorised users

Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN, Bozic KJ (2010) Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplast 25:103–107. https://doi.org/10.1016/j.arth.2010.04.011

Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, Rubash HE, Berry DJ (2010) The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 468:45–51. https://doi.org/10.1007/s11999-009-0945-0 CrossRefPubMed

Trampuz A, Osmon DR, Hanssen AD, Steckelberg JM, Patel R (2003) Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 414:69–88. https://doi.org/10.1097/01.blo.0000087324.60612.93 CrossRef

Del Pozo JL, Patel R (2009) Clinical practice. Infection associated with prosthetic joints. N Engl J Med 361:787–794. https://doi.org/10.1056/NEJMcp0905029 CrossRefPubMedPubMedCentral

Nodzo SR, Bauer T, Pottinger PS, Garrigues GE, Bedair H, Deirmengian CA, Segreti J, Blount KJ, Omar IM, Parvizi J (2015) Conventional diagnostic challenges in periprosthetic joint infection. J Am Acad Orthop Surg 23(Suppl):S18–S25. https://doi.org/10.5435/jaaos-d-14-00385 CrossRefPubMed

Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663. https://doi.org/10.1056/NEJMoa061588 CrossRefPubMed

Ryu SY, Greenwood-Quaintance KE, Hanssen AD, Mandrekar JN, Patel R (2014) Low sensitivity of periprosthetic tissue PCR for prosthetic knee infection diagnosis. Diagn Microbiol Infect Dis 79:448–453. https://doi.org/10.1016/j.diagmicrobio.2014.03.021 CrossRefPubMed

Morbach H, Schneider P, Schwarz T, Hofmann C, Raab P, Neubauer H, Duren C, Beer M, Girschick HJ (2012) Comparison of magnetic resonance imaging and 99mTechnetium-labelled methylene diphosphonate bone scintigraphy in the initial assessment of chronic non-bacterial osteomyelitis of childhood and adolescents. Clin Exp Rheumatol 30:578–582PubMed

Lehrer RI, Ganz T (1992) Defensins: endogenous antibiotic peptides from human leukocytes. CIBA Found Symp 171:276–290 discussion 290-273PubMed

10.

Wyatt MC, Beswick AD, Kunutsor SK, Wilson MJ, Whitehouse MR, Blom AW (2016) The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis. J Bone Joint Surg Am 98:992–1000. https://doi.org/10.2106/jbjs.15.01142

11.

Xie K, Qu X, Yan M (2016) Procalcitonin and alpha-defensin for diagnosis of periprosthetic joint infections. J Arthroplast. https://doi.org/10.1016/j.arth.2016.10.001

12.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(264–269):w264CrossRef

13.

Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. https://doi.org/10.7326/0003-4819-155-8-201110180-00009 CrossRefPubMed

14.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clin Res Ed) 327:557–560. https://doi.org/10.1136/bmj.327.7414.557 CrossRef

15.

Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135CrossRefPubMed

16.

Altman DG, Bland JM (2003) Interaction revisited: the difference between two estimates. BMJ (Clin Res Ed) 326:219CrossRef

17.

Fagan TJ (1975) Letter: Nomogram for Bayes theorem. N Engl J Med 293:257. https://doi.org/10.1056/nejm197507312930513 PubMed

18.

Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG (2011) New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994. https://doi.org/10.1007/s11999-011-2102-9 CrossRefPubMedPubMedCentral

19.

Frangiamore SJ, Saleh A, Grosso MJ, Kovac MF, Higuera CA, Iannotti JP, Ricchetti ET (2015) alpha-defensin as a predictor of periprosthetic shoulder infection. J Shoulder Elb Surg 24:1021–1027. https://doi.org/10.1016/j.jse.2014.12.021

20.

Bingham J, Clarke H, Spangehl M, Schwartz A, Beauchamp C, Goldberg B (2014) The alpha defensin-1 biomarker assay can be used to evaluate the potentially infected total joint arthroplasty. Clin Orthop Relat Res 472:4006–4009. https://doi.org/10.1007/s11999-014-3900-7 CrossRefPubMedPubMedCentral

21.

Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J (2014) Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res 472:3254–3262. https://doi.org/10.1007/s11999-014-3543-8 CrossRefPubMedPubMedCentral

22.

Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J (2014) Combined measurement of synovial fluid alpha-Defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection. J Bone Joint Surg Am 96:1439–1445. https://doi.org/10.2106/jbjs.m.01316 CrossRefPubMed

23.

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/s11999-014-3722-7 CrossRefPubMed

24.

Deirmengian C, Kardos K, Kilmartin P, Gulati S, Citrano P, Booth RE Jr (2015) The alpha-defensin test for periprosthetic joint infection responds to a wide spectrum of organisms. Clin Orthop Relat Res 473:2229–2235. https://doi.org/10.1007/s11999-015-4152-x

25.

Bonanzinga T, Zahar A, Dutsch M, Lausmann C, Kendoff D, Gehrke T (2016) How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study. Clin Orthop Relat Res. https://doi.org/10.1007/s11999-016-4906-0

26.

Frangiamore SJ, Gajewski ND, Saleh A, Farias-Kovac M, Barsoum WK, Higuera CA (2016) Alpha-defensin accuracy to diagnose periprosthetic joint infection-best available test? J Arthroplast 31:456–460. https://doi.org/10.1016/j.arth.2015.09.035

27.

Kasparek MF, Kasparek M, Boettner F, Faschingbauer M, Hahne J, Dominkus M (2016) Intraoperative diagnosis of periprosthetic joint infection using a novel alpha-defensin lateral flow assay. J Arthroplast. https://doi.org/10.1016/j.arth.2016.05.033

28.

Suda AJ, Tinelli M, Beisemann ND, Weil Y, Khoury A, Bischel OE (2017) Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found. Int Orthop 41:1307-1313. https://doi.org/10.1007/s00264-017-3412-7

29.

Sigmund IK, Holinka J, Gamper J, Staats K, Bohler C, Kubista B, Windhager R (2017) Qualitative alpha-defensin test (Synovasure) for the diagnosis of periprosthetic infection in revision total joint arthroplasty. Bone Joint J 99-b:66–72. https://doi.org/10.1302/0301-620x.99b1.bjj-2016-0295.r1 CrossRefPubMed

30.

Christensen CP, Bedair H, Della Valle CJ, Parvizi J, Schurko B, Jacobs CA (2013) The natural progression of synovial fluid white blood-cell counts and the percentage of polymorphonuclear cells after primary total knee arthroplasty: a multicenter study. J Bone Joint Surg Am 95:2081–2087. https://doi.org/10.2106/jbjs.l.01646 CrossRefPubMed

31.

Bauer TW, Hayashi R (2012) The role of the pathologist in diagnosing periprosthetic infection. Surg Pathol Clin 5:67–77. https://doi.org/10.1016/j.path.2011.10.001

32.

Milone MT, Kamath AF, Israelite CL (2014) Converting between high- and low-sensitivity C-reactive protein in the assessment of periprosthetic joint infection. J Arthroplast 29:685–689. https://doi.org/10.1016/j.arth.2013.09.015 CrossRef

33.

Ettinger M, Calliess T, Kielstein JT, Sibai J, Bruckner T, Lichtinghagen R, Windhagen H, Lukasz A (2015) Circulating biomarkers for discrimination between aseptic joint failure, low-grade infection, and high-grade septic failure. Clin Infect Dis Off Publ Infect Dis Soc Am 61:332–341. https://doi.org/10.1093/cid/civ286 CrossRef

34.

Shahi A, Parvizi J (2016) The role of biomarkers in the diagnosis of periprosthetic joint infection. EFORT Open Rev 1:275–278. https://doi.org/10.1302/2058-5241.1.160019 CrossRefPubMedPubMedCentral

35.

Alvand A, Rezapoor M, Parvizi J (2017) The role of biomarkers for the diagnosis of implant-related infections in orthopaedics and trauma. Adv Exp Med Biol 971:69–79. https://doi.org/10.1007/5584_2017_11

36.

Shahi A, Parvizi J, Kazarian GS, Higuera C, Frangiamore S, Bingham J, Beauchamp C, Valle CD, Deirmengian C (2016) The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration. Clin Orthop Relat Res 474:1610–1615. https://doi.org/10.1007/s11999-016-4726-2

Title: Diagnostic accuracy of alpha-defensin in periprosthetic joint infection: a systematic review and meta-analysis
Authors: Jun Yuan
Yufei Yan
Jiong Zhang
Bibo Wang
Jianmin Feng
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3647-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Diagnostic accuracy of alpha-defensin in periprosthetic joint infection: a systematic review and meta-analysis

Abstract

Background

Method

Result

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Method

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2017

Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position

Results of arthroscopic Bankart repair with Hill-Sachs remplissage for anterior shoulder instability

Evaluation of different surgical methods in treating recurrent patella dislocation after three-dimensional reconstruction

Metallic ion release after knee prosthesis implantation: a prospective study

The AES total ankle arthroplasty analysis of failures and survivorship at ten years

Pediatric Orthopaedics - from Kirschner wires to titanium