Synovial Fluid Alpha-Defensin Is an Adjunctive Tool in the Equivocal Diagnosis of Periprosthetic Joint Infection

The Journal of Arthroplasty
Mick P KellyCraig J Della Valle

Abstract

Synovial fluid alpha-defensin has shown to be a reliable diagnostic test for the diagnosis of periprosthetic joint infection (PJI), but its use in equivocal cases has yet to be established. The purpose of this study was to determine the reliability of alpha-defensin testing in patients, where the diagnosis of PJI was unclear. A consecutive series of 41 synovial aspirations by a single surgeon that were sent for alpha-defensin testing in equivocal cases of PJI were retrospectively reviewed. Indications for alpha-defensin testing included recent antibiotic use, borderline synovial fluid cell count, and differential, suspected culture-negative infection, and suspected false-positive culture. PJI was diagnosed using the Musculoskeletal Infection Society (MSIS) criteria. Of the 39 aspirations in 32 patients included in the study, there were 33 (85%) knee and 6 (15%) hip samples. Eleven (28%) samples met MSIS criteria for PJI. Of the 23 samples that had recent antibiotic use (6 MSIS positive, 17 negative), alpha-defensin results confirmed the correct MSIS diagnosis in 19 (83%) samples. Of the 11 samples in which alpha-defensin testing was performed for a borderline cell count (3 MSIS positive, 8 negative), alpha-defensin confirmed th...Continue Reading

Citations

Feb 12, 2020·Surgical Infections·Ellis BernsDioscaris R Garcia
Oct 24, 2019·International Orthopaedics·Cheng LiCristina Ojeda-Thies
May 1, 2020·The Bone & Joint Journal·Derek F AmanatullahStuart B Goodman
Aug 10, 2020·The Journal of Bone and Joint Surgery. American Volume·Amy S WasterlainJavad Parvizi
Jun 25, 2020·Arthroplasty Today·Daniel J ChernoffThomas L Shriwise
Jan 3, 2021·The Journal of Arthroplasty·Lindsay T Kleeman-ForsthuberJason M Jennings
May 7, 2021·Skeletal Radiology·Thanat KanthawangThomas M Link

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