Diagnostic accuracy of interleukin-6 and procalcitonin in patients with periprosthetic joint infection: a systematic review and meta-analysis

Background: Periprosthetic joint infection (PJI) is the most common complication after artificial joint replacement as previously reported. However, the main problem at present is its difficulty in diagnosis. This systematic review and meta-analysis aimed to compare the diagnostic accuracy of α-defensin, D-dimer, and interleukin-6 (IL-6) in clinical practice. Method: Online databases were systematically searched until June 18th, 2020 with keywords and medical sub-headings terms. Studies mentioned the sensitivity and specificity of biological markers in detecting PJI were included in our study. The sensitivity, specificity, and diagnostic odds ratios (DORs) were obtained after integration. Results: A total of 34 studies with 1036 patients diagnosing as PJI were included for comparing α-defensin, D-dimer, and IL-6. The sensitivity and specificity of α-defensin for PJI were 0.88 and 0.96, and the DOR was 189 (95% CI 72–496), respectively. The sensitivity and specificity of D-dimer (0.82 and 0.72) and IL-6 (0.80 and 0.89) were lower than α-defensin. Conclusion: The detection of α-defensin is a promising biomarker for diagnosing PJI. The optional cut-off needs to be curtained when using other biomarkers.

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Effectiveness of diluted povidone-iodine lavage for preventing periprosthetic joint infection: an updated systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02703-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Naomi Kobayashi ◽

Emi Kamono ◽

Kento Maeda ◽

Toshihiro Misumi ◽

Yohei Yukizawa ◽

...

Keyword(s):

Systematic Review ◽

Periprosthetic Joint Infection ◽

Fixed Effects ◽

Povidone Iodine ◽

Meta Analysis ◽

Joint Infection ◽

Assessment Process ◽

Cochrane Library ◽

Saline Control ◽

Control Group

Abstract Background Of the several methods used to prevent surgical site infection (SSI), diluted povidone-iodine (PI) lavage is used widely. However, the clinical utility of PI for preventing periprosthetic joint infection (PJI) remains controversial. The aim of this study was to perform a systematic review and meta-analysis of the utility of dilute PI lavage for preventing PJI in primary and revision surgery. Methods This study was conducted in accordance with the PRISMA checklist for systematic reviews and meta-analyses. A comprehensive literature search of PubMed, CINAHL, ClinicalTrials.gov, and Cochrane Library databases was performed. The results are summarized qualitatively and as a meta-analysis of pooled odds ratios with 95% confidence intervals (95% CIs). Heterogeneity of treatment effects among studies was classified as low, moderate, or high, corresponding to I2 values of < 25%, 25–50%, and > 50%. A random effects model was applied in cases of high heterogeneity; otherwise, the fixed effects model was applied. Subgroup analyses were conducted to identify potential sources of heterogeneity. Results After the screening and eligibility assessment process, eight studies were finally extracted for analysis. Overall, the results showed that PI had no significant effect on PJI with ununified control group. However, subgroup analysis of studies with a saline control group revealed an odds ratio of 0.33 (95% CI, 0.16–0.71) for the PI group, suggesting a significant effect for preventing PJI. Conclusion The systematic review and meta-analysis of the current literature demonstrates that diluted PI lavage is significantly better than saline solution lavage for preventing PJI. Level of evidence Level I, Systematic review and meta-analysis.

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Correlation between body mass index and two-stage revision failure of periprosthetic joint infection following total joint arthroplasty: A systematic review and meta-analysis

Journal of Orthopaedic Surgery ◽

10.1177/23094990211055231 ◽

2021 ◽

Vol 29 (3) ◽

pp. 230949902110552

Author(s):

Junbiao Guo ◽

Shuxu Wu ◽

Huimin Wang ◽

Wenzhi Chen ◽

Xiaoqiang Deng

Keyword(s):

Systematic Review ◽

Body Mass Index ◽

Publication Bias ◽

Periprosthetic Joint Infection ◽

Total Joint Arthroplasty ◽

Subgroup Analysis ◽

Meta Analysis ◽

Joint Infection ◽

Joint Arthroplasty ◽

Two Stage

Background: Although the correlation between body mass index (BMI) and two-stage revision failure of periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) have been frequently reported, the results remain controversial. Therefore, the correlation between them was systematically evaluated and meta-classified in this study. Methods: Literature on the correlation between BMI and two-stage revision failure of PJI following TJA was retrieved in PubMed, Embase and Cochrane Library due May 2020. Stata 13.0 software and Cochrane Collaboration Review Manager software (RevMan version 5.3) were applied to data synthesis, subgroup analysis, analyses of publication bias, and sensitivity. Results: A total of 15 observational studies included 1267 patients, of which 15 studies were included in systematic review and 11 studies in meta-analysis. Eight studies found a correlation between BMI and two-stage revision failure of PJI following TJA, but seven other studies found no correlation. Meta-analysis found that the risk of two-stage revision failure of PJI following TJA significantly boosted by 3.53 times in patients with BMI ≥ 30 kg/m2 (OR = 3.53; 95% CI = 1.63–7.64 for the BMI ≥ 30 kg/m2 vs. BMI < 30 kg/m2) and the risk of two-stage revision failure of PJI following TJA significantly increased by 2.92 times in patients with BMI ≥ 40 kg/m2 ( OR = 2.92; 95% CI = 1.06–8.03 for the BMI ≥ 40 kg/m2 vs. BMI < 30 kg/m2). The subgroup analysis showed that significant association was observed among the studies performed in TKA ( OR = 3.63; 95% CI = 2.27–5.82), but not among those conducted in THA ( OR = 3.06; 95% CI = 0.42–22.19). A significant association remained consistent, as indicated by sensitivity analyses. Because there are too few studies that can be combined in the included studies, Egger’s and Begg’s tests were not performed. Conclusion: Meta-analysis suggests that the risk of two-stage revision failure of PJI following TJA significantly boosted in obese patients. However, because there may be publication bias of this study, combined overall systematically evaluated and meta-analysis results, we cannot yet conclude that BMI is associated with two-stage revision failure of PJI following TJA.

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The role of D-dimer in periprosthetic joint infection: a systematic review and meta-analysis

Diagnosis ◽

10.1515/dx-2021-0032 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Giovanni Balato ◽

Cristiano De Franco ◽

Fiamma Balboni ◽

Vincenzo De Matteo ◽

Tiziana Ascione ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Blood Sample ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

Negative Likelihood Ratio ◽

Diagnostic Odds Ratio ◽

Receiver Operating Curve ◽

Sensitivity Specificity ◽

D Dimer

Abstract Objectives The current literature on diagnosis of periprosthetic joint infection (PJI) provides controversial evidence on the diagnostic accuracy of D-dimer. Therefore, this critical literature search and meta-analysis was aimed to summarize the diagnostic accuracy of D-dimer for diagnosing PJI. Content We searched MEDLINE, Scopus, and Web of Science, for studies on D-dimer for diagnosing PJI, according to the PRISMA flowchart. QUADAS was used for assessing study quality. Sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were analyzed using bivariate diagnostic random-effects model. The area under the receiver-operating curve (AUC-ROC) was calculated. Subgroup analysis and univariate meta-regression were carried out for detecting potential sources of heterogeneity. Summary We included 12 articles, totaling 1,818 patients (539 with PJI). The pooled sensitivity and specificity of D-dimer for diagnosing PJI were 0.739 (95% CI: 0.616–0.833) and 0.785 (95% CI: 0.679–0.863). The pooled PLR, NLR, DOR were 3.359 (95% CI, 2.340–4.821), 0.295 (95% CI, 0.180–0.484), and 11.787 (95% CI, 5.785–24.018). The cumulative ROC plot displayed an AUC of 0.688 (95% CI, 0.663–0.713; p<0.001). No threshold effects could be observed. The type of blood sample was identified as possible source of heterogeneity for DOR (p=0.01). Outlook Evidence emerged from this meta-analysis suggests that D-dimer displays sufficient diagnostic accuracy to rule out PJI. The type of blood sample (plasma vs. serum) and the study design could influence the results in terms of DOR and sensitivity. However, further perspective studies would be needed to validate its potential diagnostic usefulness.

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Alpha-Defensin versus Leukocyte Esterase in Periprosthetic Joint Infection: An Updated Meta-Analysis

BioMed Research International ◽

10.1155/2020/3704285 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14

Author(s):

Zhizhuo Li ◽

Qingyu Zhang ◽

Lijun Shi ◽

Fuqiang Gao ◽

Wei Sun ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Periprosthetic Joint Infection ◽

Data Extraction ◽

Meta Analysis ◽

Joint Infection ◽

Area Under The Curve ◽

Cochrane Library ◽

Systematic Research ◽

High Diagnostic Accuracy

Periprosthetic joint infection (PJI) is a devastating complication after arthroplasty. Prompt establishment of an infection diagnosis is critical but can be very challenging at present. In order to evaluate the diagnostic accuracy of alpha-defensin or leukocyte esterase for PJI, we performed systematic research in PubMed, Embase, and Cochrane Library to retrieve relevant studies. Data extraction and quality assessment were performed by two reviewers independently. A total of thirty-one eligible studies were finally included in the quantitative analysis. The pooled sensitivity and specificity of alpha-defensin (21 studies) for the diagnosis of PJI were 0.89 (95% confidence interval (CI), 0.83 to 0.93) and 0.96 (95% CI, 0.95 to 0.97), respectively. The value of the pooled diagnostic odds ratios (DOR) of alpha-defensin for PJI was 209.14 (95% CI, 97.31 to 449.50), and the area under the curve (AUC) was 0.98 (95% CI, 0.96 to 0.99). The pooled sensitivity and specificity of leukocyte esterase (17 studies) for the diagnosis of PJI were 0.90 (95% CI, 0.84 to 0.95) and 0.96 (95% CI, 0.93 to 0.97), respectively. The value of the DOR of leukocyte esterase for PJI was 203.23 (95% CI, 96.14 to 429.61), and the AUC was 0.98 (95% CI, 0.96 to 0.99). Based on the results of our meta-analysis, we can conclude that alpha-defensin and leukocyte esterase are valuable synovial fluid markers for identifying PJI with comparable high diagnostic accuracy.

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Periprosthetic joint infection rates across primary total hip arthroplasty surgical approaches: a systematic review and meta-analysis of 653,633 procedures

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04186-3 ◽

2021 ◽

Author(s):

Alexander J. Acuña ◽

Michael T. Do ◽

Linsen T. Samuel ◽

Daniel Grits ◽

Jesse E. Otero ◽

...

Keyword(s):

Systematic Review ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

Surgical Approaches ◽

Infection Rates ◽

Total Hip ◽

Primary Total Hip Arthroplasty

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Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1395-3 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 10

Author(s):

Yisheng Chen ◽

Xueran Kang ◽

Jie Tao ◽

Yunpeng Zhang ◽

Chenting Ying ◽

...

Keyword(s):

Systematic Review ◽

Synovial Fluid ◽

Periprosthetic Joint Infection ◽

Meta Analysis ◽

Joint Infection ◽

High Specificity ◽

Diagnostic Efficiency ◽

Operating Characteristics ◽

Musculoskeletal Infection ◽

Sensitivity Specificity

Abstract Background Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI. Methods We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis. Results After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84–90%), 96% (95% CI 95–97%), and 170.09 (95% CI 97.63–296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83–90%), 97% (95% CI 96–98%), and 158.18 (95% CI 74.26–336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively. Conclusion Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.

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