A profile on the Synovasure alpha defensin test for the detection of periprosthetic infections

ABSTRACT

Introduction

Clinicians have waited a long time for a ‘universal’ marker that may help them distinguish infected from non-infected total joint arthroplasties when doubts persist after using classical clinical and biological signs of infection. In recent years, synovial fluid biomarkers including leukocyte esterase, alpha-defensins, and CRP have shown promising results for the diagnosis of periprosthetic joint infections (PJIs).

Areas covered

This review provides an overview of the rational and the use of the Synovasure® alpha-defensin tests in patients with a suspicion of PJI. Using a systematic investigation by keywords, we looked for all citations (and the citations to these citations) of the selected papers.

Expert opinion

The Synovasure® alpha-defensin tests demonstrate high potential for the diagnosis of PJIs. However, the data currently available also show that the universal marker of infection in the settings of PJIs is still to be discovered.

KEYWORDS:

• Alpha defensin
• periprosthetic joint infections
• synovial biomarkers

Article highlights

• No single diagnostic test is currently capable of infallibly separating infected from non-infected total arthroplasties

• Synovial fluid biomarkers especially Alpha-Defensins (ADs) have shown promising results for the diagnosis of periprosthetic joint infections (PJIs) irrespective of the pathogens involved

• Overall, the specificity of AD tests for the diagnosis of PJI is higher than sensitivity

• Both AD immunoassay (ADIA) and AD lateral flow (ADLF) tests have shown high diagnostic accuracy but the best results have been reported with the use the ADIA test

• Conversely to ADIA test, ADLF test can be used intraoperatively due to its short turnaround time and high specificity

• Synovial AD tests diagnostic accuracy is not influenced by previous or ongoing antibiotic therapy

• The specificity of AD tests may be reduced in case of metallosis or crystal deposition diseases

• Synovial AD tests have recently been included in diagnostic criteria for PJI of the Musculoskeletal Infection Society

Declaration of interest

E Senneville and H Migaud have both served as speakers for Zimmer Biomet. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.