Alpha-Defensin Offers Limited Utility in Work-Up Prior to Reimplantation in Chronic Periprosthetic Joint Infection in Total Joint Arthroplasty Patients.
Humans
alpha-Defensins
Prosthesis-Related Infections
/ diagnosis
C-Reactive Protein
/ analysis
Arthroplasty, Replacement, Knee
/ adverse effects
Arthroplasty, Replacement, Hip
/ adverse effects
Retrospective Studies
Sensitivity and Specificity
Arthritis, Infectious
/ surgery
Synovial Fluid
/ chemistry
Replantation
Biomarkers
alpha-defensin
infection
periprosthetic infection
synovasure
total hip arthroplasty
total knee arthroplasty
Journal
The Journal of arthroplasty
ISSN: 1532-8406
Titre abrégé: J Arthroplasty
Pays: United States
ID NLM: 8703515
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
received:
30
03
2022
revised:
27
06
2022
accepted:
29
06
2022
pubmed:
9
7
2022
medline:
24
11
2022
entrez:
8
7
2022
Statut:
ppublish
Résumé
Alpha-defensin (AD) is a synovial biomarker included in the 2018 consensus criteria for diagnosing periprosthetic joint infection (PJI). Its value in assessing eradication of infection prior to second stage reimplantation is unclear. The purpose of this study was to evaluate the impact of AD on eligibility for reimplantation following resection for chronic PJI. This study included patients who previously underwent resection arthroplasty for PJI. Synovial fluid aspirated from 87 patients was retrospectively reviewed. All patients completed a 6-week course of intravenous antibiotics and an appropriate drug holiday. Synovial white blood cell count, percentage neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 consensus criteria was used, including white blood cell count, percentage neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then added to determine if it changed diagnosis or clinical management. Four patients were categorized as "infected" (score >6), none exhibited a positive AD or positive culture. Sixty eight patients were diagnosed as "possibly infected" (score 2 to 5), none had a positive AD, and one had a positive culture (Cutibacterium acnes). AD did not change the diagnosis from "possibly infected" to "infected" in any case or alter treatment plans. Fifteen patients had a score of <2 (not infected) and none had a positive AD. The routine use of AD in the work-up prior to a second-stage arthroplasty procedure for PJI may not be warranted.
Sections du résumé
BACKGROUND
Alpha-defensin (AD) is a synovial biomarker included in the 2018 consensus criteria for diagnosing periprosthetic joint infection (PJI). Its value in assessing eradication of infection prior to second stage reimplantation is unclear. The purpose of this study was to evaluate the impact of AD on eligibility for reimplantation following resection for chronic PJI.
METHODS
This study included patients who previously underwent resection arthroplasty for PJI. Synovial fluid aspirated from 87 patients was retrospectively reviewed. All patients completed a 6-week course of intravenous antibiotics and an appropriate drug holiday. Synovial white blood cell count, percentage neutrophils, and culture from the AD immunoassay laboratory were reviewed with serum erythrocyte sedimentation rate and C-reactive protein values from our institution. A modified version of the 2018 consensus criteria was used, including white blood cell count, percentage neutrophils, erythrocyte sedimentation rate, and C-reactive protein. AD was then added to determine if it changed diagnosis or clinical management.
RESULTS
Four patients were categorized as "infected" (score >6), none exhibited a positive AD or positive culture. Sixty eight patients were diagnosed as "possibly infected" (score 2 to 5), none had a positive AD, and one had a positive culture (Cutibacterium acnes). AD did not change the diagnosis from "possibly infected" to "infected" in any case or alter treatment plans. Fifteen patients had a score of <2 (not infected) and none had a positive AD.
CONCLUSION
The routine use of AD in the work-up prior to a second-stage arthroplasty procedure for PJI may not be warranted.
Identifiants
pubmed: 35803520
pii: S0883-5403(22)00686-6
doi: 10.1016/j.arth.2022.06.024
pii:
doi:
Substances chimiques
alpha-Defensins
0
C-Reactive Protein
9007-41-4
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2431-2436Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.