Are Accuracy Studies for Periprosthetic Joint Infection Diagnosis Inherently Flawed? And What to Do with Schrödinger’s Hips? A Prospective Analysis of the Alpha Defensin Lateral-Flow Test in Chronic Painful Hip Arthroplasties
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Purpose: The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alphadefensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods: Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain “Schrödinger’s hips”: in such cases PJI cannot be excluded nor confirmed until you “open the box”. Results: The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion: The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of “Schrödinger’s hips”
Abstract
Purpose: The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alphadefensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods: Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain “Schrödinger’s hips”: in such cases PJI cannot be excluded nor confirmed until you “open the box”. Results: The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion: The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of “Schrödinger’s hips”
참고문헌 (16)
- Osmon DR, "Diagnosis and management of prosthetic joint infection : clinical practice guidelines by the Infectious Diseases Society of America", Clin Infect Dis, 56, pp.e1~e25 (2013)[DOI]
- Bozic KJ, "The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization", J Bone Joint Surg Am, 87, pp.1746~1751 (2005)[DOI]
- Parvizi J, "New definition for periprosthetic joint infection : from the Workgroup of the Musculoskeletal Infection Society", Clin Orthop Relat Res, 469, pp.2992~2994 (2011)[DOI]
- Parvizi J, "The 2018 definition of periprosthetic hip and knee infection : an evidence-based and validated criteria", J Arthroplasty, 33, pp.1309~1314 (2018)[DOI]
- Zmistowski B, "Diagnosis of periprosthetic joint infection", J Orthop Res, 1, pp.S98~S107 (2014)[DOI]
- Shohat N, "Hip and knee section, what is the definition of a periprosthetic joint infection (PJI)of the knee and the hip? Can the same criteria be used for both joints?: proceedings of international consensus on orthopedic infections", J Arthroplasty, 34(2S), pp.S325~S327 (2019)
- Kuiper JWP, "Does the alpha defensin ELISA test perform better than the alpha defensin lateral flow test for PJI diagnosis? A systematic review and meta-analysis of prospective studies", Clin Orthop Relat Res, 478, pp.1333~1344 (2020)[DOI]
- Weigelt L, "Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections", Int Orthop, 44, pp.1023~1029 (2020)[DOI]
- McNally M, "The EBJIS definition of periprosthetic joint infection", Bone Joint J, 103-B, pp.18~25 (2021)[DOI]
- A Rutjes, "Evaluation of diagnostic tests when there is no gold standard. A review of methods", Health Technology Assessment, 11(50) (2007), National Institute for Health Research[DOI]
- Okroj KT, "The alpha-defensin test for diagnosing periprosthetic joint infection in the setting of an adverse local tissue reaction secondary to a failed metalon-metal bearing or corrosion at the head-neck junction", J Arthroplasty, 33, pp.1896~1898 (2018)[DOI]
- Balato G, "High performance of α-defensin lateral flow assay(Synovasure)in the diagnosis of chronic knee prosthetic infections", Knee Surg Sports Traumatol Arthrosc, 26, pp.1717~1722 (2018)[DOI]
- Deirmengian C, "Combined measurement of synovial fluidα-defensin and C-reactive protein levels : highly accurate for diagnosing periprosthetic joint infection", J Bone Joint Surg Am, 96, pp.1439~1445 (2014)[DOI]
- Bonanzinga T, "How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study", Clin Orthop Relat Res, 475, pp.408~415 (2017)[DOI]
- Shahi A, "The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration", Clin Orthop Relat Res, 474, pp.1610~1615 (2016)
- Jacobs AME, "The unsuspected prosthetic joint infection : incidence and consequences of positive intra-operative cultures in presumed aseptic knee and hip revisions", Bone Joint J, REF063303774, pp.1482~1489 (2017)[DOI]