High-Fidelity Point-of-Care Diagnostic Test for Periprosthetic Joint Infection

2018 ◽  
Vol 100 (1) ◽  
pp. e7 ◽  
Author(s):  
Garth D. Ehrlich ◽  
Michael P. Palmer
Keyword(s):  
Diagnostic Test ◽  
Periprosthetic Joint Infection ◽  
Point Of Care ◽  
Joint Infection ◽  
High Fidelity

scholarly journals Serum D-Lactate, a Novel Serological Biomarker, Is Promising for the Diagnosis of Periprosthetic Joint Infection

2022 ◽  
Author(s):  
Yanyang Chen ◽  
Huhu Wang ◽  
Xiyao Chen ◽  
Hairong Ma ◽  
Jingjie Zheng ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Operating Characteristic ◽  
Point Of Care ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Roc Curves ◽  
Serological Screening ◽  
Musculoskeletal Infection ◽  
Highly Sensitive ◽  
Diagnostic Values

Abstract Background: Although many markers are used for diagnosis of periprosthetic joint infection (PJI), serological screening and diagnosis for PJI are still challenging. We evaluated the performance of serum D-lactate and compared it with ESR, coagulation-related biomarkers and synovial D-lactate for the diagnosis of PJI.Methods: Consecutive patients with preoperative blood and intraoperative joint aspiration of a prosthetic hip or knee joint before revision arthroplasty were prospectively included. The diagnosis of PJI was based on the criteria of the Musculoskeletal Infection Society, and the diagnostic values of markers were estimated based on receiver operating characteristic (ROC) curves by maximizing sensitivity and specificity using optimal cutoff values.Results: Of 52 patients, 26 (50%) were diagnosed with PJI, and 26 (50%) were diagnosed with aseptic failure. ROC curves showed that serum D-lactate, fibrinogen (FIB) and ESR had equal areas under the curve (AUCs) of 0.80, followed by D-dimer and fibrin degradation product, which had AUCs of 0.67 and 0.69, respectively. Serum D-lactate had the highest sensitivity of 88.46% at the optimal threshold of 1.14 mmol/L, followed by FIB and ESR, with sensitivities of 80.77% and 73.08%, respectively, while there were no significant differences in specificity (73.08%, 73.08% and 76.92%, respectively). Conclusion: Serum D-lactate showed similar performance to FIB and ESR for diagnosis of PJI. The advantages of serum D-lactate are pathogen-specific, highly sensitive, minimally invasive and rapidly available making serum D-lactate useful as a point-of-care screening test for PJI.

α-Defensin point-of-care test for diagnosis of prosthetic joint infections: neglected role of laboratory and clinical pathologists

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Lorenzo Drago ◽  
Marco Toscano ◽  
Lorenza Tacchini ◽  
Giuseppe Banfi
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Point Of Care ◽  
Joint Infection ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Microbial Infection ◽  
Point Of Care Test ◽  
Orthopedic Surgeons ◽  
Prosthetic Joint Infections

AbstractPeriprosthetic joint infection (PJI) is a serious complication that may occur after native joint replacement leading to a severe health and economic burden. Currently, due to several confounding factors, PJI is difficult to diagnose. Today, a multidisciplinary approach is indispensable to correctly define a periprosthetic joint infection; indeed, tissue histology, microbiology cultures and clinical findings are used together to achieve this goal. Analysis of α-defensin is commonly used for PJI diagnosis, as it allows the rapid detection of α-defensin present in the synovial fluid following a microbial infection. Currently, a point-of-care testing (POCT) assay able to detect the presence of human α-defensins 1–3 in synovial fluid of patients is aimed directly at orthopedic surgeons. However, many orthopedic surgeons lack experience and training in quality laboratory practices, often failing to appreciate the significance of quality control and proper documentation when using POCT assays. To guarantee the highest quality diagnostic services, the α-defensin test should be used together with other biochemical and microbiological criteria commonly used for PJI diagnosis. Additionally, the close cooperation and communication between laboratory, pathologists and physicians is of fundamental importance in the correct diagnosis of PJI.

Diagnosis of periprosthetic joint infection using alpha-defensin test or multiplex-PCR: ideal diagnostic test still not found

2017 ◽  
Vol 41 (7) ◽  
pp. 1307-1313 ◽  
Author(s):  
Arnold J. Suda ◽  
Marco Tinelli ◽  
Nils D. Beisemann ◽  
Yoram Weil ◽  
Amal Khoury ◽  
...  
Keyword(s):  
Multiplex Pcr ◽  
Diagnostic Test ◽  
Periprosthetic Joint Infection ◽  
Joint Infection

scholarly journals Periprosthetic Joint Infection

2019 ◽  
Vol 2019 ◽  
pp. 1-2
Author(s):  
Bernd Fink ◽  
Konstantinos Anagnostakos ◽  
Heinz Winkler
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection

Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 3S-4S
Author(s):  
Ilker Uçkay ◽  
Christopher B. Hirose ◽  
Mathieu Assal
Keyword(s):  
Periprosthetic Joint Infection ◽  
Corticosteroid Injection ◽  
Joint Infection ◽  
Invasive Procedure ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Strong Consensus ◽  
Healthcare Associated ◽  
The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

scholarly journals Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 434
Author(s):  
Frank Sebastian Fröschen ◽  
Sophia Schell ◽  
Matthias Dominik Wimmer ◽  
Gunnar Thorben Rembert Hischebeth ◽  
Hendrik Kohlhof ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Multiple Regression ◽  
Complement System ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Expression Patterns ◽  
Factor H ◽  
Low Grade ◽  
Complement Factors ◽  
Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

Periprosthetic Joint Infection after Elbow Arthroplasty

2021 ◽  
pp. 231-249
Author(s):  
Yvonne Achermann ◽  
Michael C. Glanzmann ◽  
Christoph Spormann
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Elbow Arthroplasty

scholarly journals The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hao Li ◽  
Rui Li ◽  
L. L. Li ◽  
Wei Chai ◽  
Chi Xu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Periprosthetic Joint Infection ◽  
Retrospective Cohort Study ◽  
Persistent Infection ◽  
Retrospective Cohort ◽  
Joint Infection ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Coagulation Profile ◽  
Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

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