Due to the lack of specificity of conventional diagnostic tools, the prediction of periprosthetic joint infections (PJI) remains challenging. The purpose of this study was to evaluate the accuracy of synovial fluid neopterin, presepsin, and TNF-α as diagnostic parameters and to compare it to the biomarkers recommended in the 2018 definition of periprosthetic hip and knee infection.Between August 2018 and July 2019, a prospective cohort study was conducted in 80 patients with painful hip, shoulder, and knee arthroplasty. In addition to medical history, clinical and laboratory data were gathered. PJI was diagnosed based on the 2018 definition of periprosthetic hip and knee infection. Synovial joint fluid was analyzed for biomarker measurement using standard quantitative enzyme immunoassay kits.Fifty-three patients (66%) were classified as the aseptic group and twenty-seven patients (34%) as the PJI group. The mean levels of synovial fluid neopterin were significantly higher (p < 0.01) in the PJI group than those in the aseptic group (aseptic 8.3 ± 6.9 vs. PJI 20.9 ± 21.4 nmol/L). The average values of synovial fluid TNF-α and presepsin were not significantly higher in the PJI group than those in the aseptic group (presepsin: aseptic 0.13 ± 0.19 vs. PJI 0.11 ± 0.32 ng/mL, p = 0.08; TNF-α: aseptic 6.6 ± 7.3 vs. PJI 46.3 ± 123.2 pg/mL, p = 0.17). Synovial fluid neopterin was 59% specific and 74% sensitive with a cut-off value of 7.2 nmol/L. The sensitivity and specificity of synovial fluid TNF-α were 63 and 51% with a cut-off value of 3.9 pg/mL. Synovial fluid presepsin was 51% specific and 29% sensitive with a cut-off value above 0.06 ng/mL.Synovial fluid neopterin appears to a reliable diagnostic marker for detection of PJI. In contrast, synovial fluid TNF-α and presepsin are not suitable to exclude or diagnose PJI.Aufgrund der Unzuverlässigkeit der aktuell zur Verfügung stehenden diagnostischen Tests bleibt die Diagnosestellung von periprothetischen Infektionen (PPI) eine Herausforderung. Das Ziel dieser Studie war es, die Zuverlässigkeit von Neopterin, Presepsin und TNF-α aus der Synovialflüssigkeit als Parameter in der Diagnostik von PPI zu bewerten und diese mit denen von Biomarkern, die in der 2018er-Definition von PPI des Knie- und Hüftgelenks empfohlen werden, zu vergleichen.Zwischen August 2018 und Juli 2019 wurde eine prospektive Kohortenstudie mit 80 Patienten, die über Schmerzen bei einliegender Endoprothese an Knie-, Schulter- und Hüftgelenk klagten, durchgeführt. Neben der Anamnese wurden klinische und laborchemische Daten erhoben. Die Diagnose PPI wurde anhand der Definition von periprothetischen Infektionen aus dem Jahr 2018 gestellt. Neopterin, TNF-alpha und Presepsin wurden mit standartisierten ELISA in der Synovialflüssigkeit gemessen ERGEBNISSE: 53 (66%) Patienten wurden als aseptisch und 27 (34%) als die PPI-Gruppe klassifiziert. Die mittleren Konzentrationen von Neopterin in der Synovialflüssigkeit waren bei Patienten mit PPI signifikant höher (p < 0,01) als in der aseptischen Gruppe (aseptisch 8,3 ± 6,9 nmol/l vs. PPI 20,9 ± 21,4 nmol/l). Die mittleren Konzentrationen von synovialem TNF-α und Presepsin waren nicht signifikant höher bei Patienten mit PPI als in der aseptischen Gruppe (Presepsin: aseptisch 0,13 ± 0,19 ng/ml vs. PPI 0,11 ± 0,32 ng/ml, p = 0,08; TNF-α: aseptisch 6,6 ± 7,3 pg/ml vs. PPI 46,3 ± 123,2 pg/ml, p = 0,17). Synoviales Neopterin zeigte eine Spezifität von 59% und eine Sensitivität von 74% bei einem Cut-off-Level von 7,2 nmol/l. Die Sensitivität und Spezifität von snyovialem TNF-α lag bei 63% und 51% bei einem Cut-off-Level von 3,9 pg/ml. Synoviales Presepsin wies eine Sepzifität von 51% und eine Sensitivität von 29% bei einem Cut-off-Level über 0,06 ng/ml auf.Synoviales Neopterin erwies sich als vielversprechender Biomarker in der Diagnostik von periprothetischen Infektionen. Synoviales TNF-α und Presepsin sind nicht geeignet, um eine periprothetische Infektion auszuschließen.
Abstract Background Since a “gold-standard” is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays. Results Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly ( p < 0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ± 0.21 ng/mL (0.0–1.03) vs. aseptic 0.02 ± 0.03 ng/mL (0.0–0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher ( p < 0.001) than those of PJI group (PJI 2.7 ± 1.4 ng/mL (0.53–9.7) vs. aseptic 8.7 ± 2.5 ng/mL (0.25–87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%. SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%. Conclusion S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Fragestellung Periprothetische Infektionen (PPI) stellen eine ernsthafte Komplikation nach endoprothetischem Gelenkersatz dar und sind aufgrund des Fehlens eines einheitlichen Gold-Standards teils schwierig zu diagnostizieren.
Abstract Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays. Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ng/mL ± 0.21 (0.0-1.03) vs. aseptic 0.02 ng/mL ± 0.03 (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ng/mL ± 1.4 (0.53-9.7) vs. aseptic 8.7 ng/mL ± 2.5 (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%. SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Abstract Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays. Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ng/mL ± 0.21 (0.0-1.03) vs. aseptic 0.02 ng/mL ± 0.03 (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ng/mL ± 1.4 (0.53-9.7) vs. aseptic 8.7 ng/mL ± 2.5 (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%. SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Abstract Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays. Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ± 0.21 ng/mL (0.0-1.03) vs. aseptic 0.02 ± 0.03 ng/mL (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ± 1.4 ng/mL (0.53-9.7) vs. aseptic 8.7 ± 2.5 ng/mL (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%.SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Background/Aim: Owing to the lack of a diagnostic gold standard, ruling out persistent periprosthetic joint infection (PJI) before second-stage surgery in the setting of two-stage revision arthroplasty constitutes a major challenge. We evaluated if the alpha-defensin-1 (AD-1) test could predict successful infection eradication before reimplantation of a new prosthesis. Patients and Methods: Our prospective study included 20 patients who underwent two-stage revision arthroplasty for treatment of PJI. A standard quantitative enzyme AD-1 immunoassay of synovial fluid, the synovial leukocyte esterase test and routine laboratory blood testing were performed prior to explantation and reimplantation. Treatment failure was defined according to the Delphi-based consensus criteria after a minimum follow-up of 1 year. Results: A 15% of our patients met the Delphi Criteria within 1 year. None of the markers investigated were significantly different in patients with and without reinfection. Conclusion: Further research is necessary to identify biomarkers more suitable for indicating persistent infection before reimplantation.
Abstract Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT and SF-PCT levels were measured using standard quantitative PCT enzyme immunoassays. Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher in the PJI group than those in the aseptic group (PJI 0.05 ± 0.21 ng/mL (0.0-1.03) vs. aseptic 0.02 ± 0.03 ng/mL (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ± 1.4 ng/mL (0.53-9.7) vs. aseptic 8.7 ± 2.5 ng/mL (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specificity of 91.0%.SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specificity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Abstract Background Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection.Methods Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. Serum PCT levels were quantified under the use of immunoassay (Centaur, Siemens, Germany). Synovial PCT levels were measured using a standard quantitative PCT enzyme immunoassay kit, according to the manufacturers' instructions (Anti-Procalcitonin antibody ab166963, ABCAM, Cambridge,UK).Results Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of serum PCT was significantly (p<0.001) higher than those in the aseptic group (PJI 0.05 ng/mL (0.0-1.03) vs. aseptic 0.02 ng/mL (0.0-0.18)). In synovial fluid, the mean values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ng/mL (0.53-9.7) vs. aseptic 8.7 ng/mL (0.25-87.9)). Serum PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specifity of 91.0%. Synvial fluid PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specifity of 52.0%.Conclusion Serum and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
Abstract Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT levels were quantified under the use of immunoassay (Centaur, Siemens, Germany). SF- PCT levels were measured using a standard quantitative PCT enzyme immunoassay kit, according to the manufacturers' instructions (Anti-Procalcitonin antibody ab166963, ABCAM, Cambridge,UK). Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher than those in the aseptic group (PJI 0.05 ng/mL (0.0-1.03) vs. aseptic 0.02 ng/mL (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ng/mL (0.53-9.7) vs. aseptic 8.7 ng/mL (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specifity of 91.0%. SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specifity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.
