Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections

ABSTRACT

Introduction

Periprosthetic joint infection (PJI) is one of the most complex complications following total joint arthroplasty. Despite significant progress in recent years, the use of blood and synovial biomarkers to diagnose PJI remains a challenge.

Areas covered

A combination of serological, synovial, microbiological, histological, and radiological investigations is suggested by consensus and international guidelines. Novel biomarkers and molecular methods have shown promise in recent years. The purpose of this review is to provide an update about the biomarkers used to diagnose PJI and highlight their sensitivity and specificity. In addition, guidance on the diagnostic steps and clinical workflow will be included.

Expert opinion

The diagnostic algorithm developed and validated by the international consensus meeting group is still the most valuable resource to approach PJI diagnosis. The current combination of blood and synovial biomarkers yield acceptable results and good performance. However, there is a need for new biomarkers and further research to understand the limitations of current tests better, as well as explore new options such as alpha-defensin, D-dimer, interleukin-6, and leukocyte esterase.

KEYWORDS:

• PJI
• diagnosis
• biomarkers
• sensitivity
• specificity

Article highlights

• The best biomarker for infection does not exist. The 2018 ICM algorithm is our best option to diagnose periprosthetic joint infection.

• ESR and CRP despite being cheap and widely used are not reliable in many occasions and should be used only to rule out infection.

• Low-virulence organism have a different behaviour and clinically present with less evidence of infections. In these cases, a full workup according to ICM criteria is particularly useful.

• Despite their individual limitations, alpha-defensin, D-dimer, interleukin-6, and leucocyte esterase should be object of future research.

Declaration of interest

J Parvizi has received royalties from Corentec, Datatrace, Elsevier, Jaypee Publishers, SLACK Incorporated, Wolters Kluwer Health - Lippincott Williams & Wilkins and provided paid consultancy for 3M, Corentec, Ethicon, Heraeus, NCI, Stryker, Tenor, TissueGene, Zimmer. He holds stock or stock options in Alphaeon, Ceribell, Corentec, Hip Innovation Technology, Intellijoint, Joint Purification Systems, MDValuate, MicroGenDx, Parvizi Surgical Innovations, Physician Recommended Nutriceutical, PRN-Veterinary. He is on the editorial board for Journal of Bone and Joint Surgery – American, and a committee member for the Eastern Orthopaedic Association and the Muller Foundation.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.