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01-06-2020 | Foreign Body Aspiration | Original Paper

Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections

Authors: Lizzy Weigelt, Andreas Plate, Laura Stadler, Reto Sutter, Dario Frustaci, Reinhard Zbinden, Patrick O. Zingg, Christian Gerber, Yvonne Achermann

Published in: International Orthopaedics | Issue 6/2020

Abstract

Purpose

Periprosthetic joint infections (PJIs) remain a challenging complication after shoulder arthroplasty. The antimicrobial peptide α-defensin has been proposed as a new synovial fluid biomarker in diagnosing PJIs. To date, only little data are available on the diagnostic accuracy of α-defensin in shoulder PJIs; thus, we aimed to evaluate its diagnostic value in a cohort of patients with a suspected shoulder PJI.

Methods

Between June 2016 and June 2018, we prospectively enrolled patients with a diagnostic shoulder aspiration due to painful shoulder arthroplasty or planned revision surgery. PJI diagnostics were performed according to the Musculoskeletal Infection Society (MSIS) criteria. All patients with an antibiotic therapy within two weeks before enrollment, insufficient amount of synovial aspirate, or bloody aspiration were excluded. α-Defensin was measured in the synovial fluid using the α-defensin lateral flow (ADLF) test (Synovasure®).

Results

Out of 60 patients, we could include 29 (59% female) patients with a mean age of 70 (range, 50–92) years. A shoulder PJI was detected in five cases (Staphylococcus aureus, n = 2; Staphylococcus epidermidis, n = 2; Cutibacterium acnes, n = 1). The ADLF test was positive in seven out of 29 cases. According to the MSIS criteria, the ADLF test was false-negative in two patients and false-positive in four patients, resulting in sensitivity, specificity, and positive and negative predictive value of 60%, 83%, 43%, and 91%, respectively. The overall accuracy was 79%.

Conclusion

The ALDF test does not appear to be useful in predicting shoulder PJIs but may be used as an additional diagnostic factor in rejecting these infections.

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Title: Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections
Authors: Lizzy Weigelt
Andreas Plate
Laura Stadler
Reto Sutter
Dario Frustaci
Reinhard Zbinden
Patrick O. Zingg
Christian Gerber
Yvonne Achermann
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Foreign Body Aspiration
Foreign Body Aspiration
Aspiration
Acne
Joint Infection
Biomarkers
Published in: International Orthopaedics / Issue 6/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04532-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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