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Synoviale Biomarker für die Differenzialdiagnostik der schmerzhaften Endoprothese

Synovial biomarkers for differential diagnosis of painful arthroplasty

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Zusammenfassung

Hintergrund

Der periprothetische Gelenkinfekt (PPI) gilt als große diagnostische und therapeutische Herausforderung. Er schmälert den Therapieerfolg, stellt eine enorme Belastung für die betroffenen Patienten dar und zieht häufig aufwendige operative Revisionen nach sich. Ein schrittweises aufwendiges diagnostisches Vorgehen ist hier bisher angezeigt, um zeit- und kostenintensive Irrläufe zu vermeiden. Die gegenwärtige (Gold-)Standarddiagnostik kommt jedoch insbesondere beim häufigen und klinisch relevanten chronischen „low-grade“-PPI an ihre Grenzen.

Einschätzung

Synoviale Biomarker zur sicheren Differenzierung einer aseptischen von der (chronischen) septischen sowie der implantatallergischen Beschwerdeursache und der Arthrofibrose werden momentan zur Überwindung der diagnostischen Lücke favorisiert. Die ambulant durchführbare Synovialpunktion ist dabei der operativen Synovial-(is-)Biopsie bei früherem Diagnosezeitpunkt, höherer Alltagspraktikabilität, geringerer Patientengefährdung und schließlich geringeren Kosten überlegen. Neben Parametern wie Interleukin-6 (IL-6), C-reaktives Protein (CRP) und Leukozytenesterase in der Gelenkflüssigkeit gelten innovative synoviale Biomarker aus der Gruppe der antimikrobiellen Peptide und proinflammatorischen Zytokine aufgrund sehr guter bis exzellenter diagnostischer Genauigkeit als besonders vielversprechend.

Schlussfolgerung

Welches (differenzial-)diagnostische Set verschiedener Biomarker bei der innovativen „one-stop-shop“-Strategie der synovialen Infektdiagnostik künftig zu favorisieren ist, müssen unabhängige Multicenter-Validierungsstudien zeigen.

Abstract

Background

The diagnosis and treatment of periprosthetic joint infection (PJI) remain true clinical challenges. PJI diminishes therapeutic success, causes dissatisfaction for the patient and medical staff, and often requires extensive surgical revision(s). At the present time, an extensive multimodal algorithmic approach is used to avoid time- and cost-consuming diagnostic aberrations. However, especially in the case of the frequent and clinically most relevant “low-grade” PJI, the current diagnostic “gold standard” has reached its limits.

Evaluation

Synovial biomarkers are thought to close this diagnostic gap, hopefully enabling the safe differentiation among aseptic, (chronic) septic, implant allergy-related and the arthrofibrotic genesis of symptomatic arthroplasty. Therefore, joint aspiration for obtaining synovial fluid is preferred over surgical synovial tissue biopsy because of the faster results, greater practicability, greater patient safety, and lower costs. In addition to the parameters synovial IL-6, CRP, and leukocyte esterase, novel biomarkers such as antimicrobial peptides and other proinflammatory cytokines are currently highlighted because of their very high to excellent diagnostic accuracy.

Conclusion

Independent multicenter validation studies are required to show whether a set of different innovative synovial fluid biomarkers rather than a few single parameters is favorable for a safe “one-stop shop” differential diagnosis of PJI.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland

    I.J. Banke, N. Stade, P.M. Prodinger, H.M. Mühlhofer, R. von Eisenhart-Rothe & H. Gollwitzer

  2. Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, Frauenlobstraße 9–11, 80337, München, Deutschland

    P. Thomas, B. Thomas & B. Summer

  3. Experimentelle Unfallchirurgie, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland

    M. van Griensven

  4. ATOS Klinik München, Effnerstr. 38, 81925, München, Deutschland

    H. Gollwitzer

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  1. I.J. Banke
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  2. N. Stade
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  6. B. Thomas
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Correspondence to I.J. Banke.

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I. J. Banke, N. Stade, P. M. Prodinger, H. M. Mühlhofer, P. Thomas, B. Thomas, B. Summer, M. van Griensven, R. von Eisenhart-Rothe und H. Gollwitzer geben an, dass kein Interessenkonflikt besteht.

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Banke, I., Stade, N., Prodinger, P. et al. Synoviale Biomarker für die Differenzialdiagnostik der schmerzhaften Endoprothese. Orthopäde 44, 934–941 (2015). https://doi.org/10.1007/s00132-015-3188-7

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