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Evaluation of myeloperoxidase in synovial fluid as a biomarker for chronic periprosthetic joint infection

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Abstract

Purpose

There is no single biomarker that can perfectly diagnose periprosthetic joint infection (PJI). As diagnosing PJI remains a major challenge, accurate and rapid development of a biomarker is required. Myeloperoxidase (MPO) is a bactericidal enzyme that acts against pathogenic microorganisms, such as those found in PJI. We aimed to determine whether elevated MPO levels could be detected in infected synovial fluid and to evaluate its utility as a biomarker for diagnosing chronic PJI.

Methods

Patients who underwent revision total joint arthroplasty were categorised into two groups according to the criteria of the second International Consensus Meeting on Musculoskeletal Infection: chronic PJI or aseptic failure. MPO was measured in synovial fluid collected during surgery. Receiver operating characteristic curves were drawn, and the area under the curve, 95% confidence intervals, and sensitivity/specificity were calculated.

Results

Synovial fluid was obtained from 37 patients. Nineteen patients were categorised into the chronic PJI group and 18 in the aseptic failure group. MPO levels in the synovial fluid were significantly higher in the chronic PJI group than in the aseptic failure group (p < 0.001). This measurement demonstrated the diagnostic accuracy of MPO for diagnosing chronic PJI with high sensitivity and specificity.

Conclusion

Although the results are debatable owing to the small sample size, measurement of MPO demonstrates high accuracy as a biomarker for diagnosing chronic PJI, and it may detect culture-negative chronic PJI. Furthermore, MPO can measure host response to chronic PJI without the potential of contamination.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Shinsuke Ikeda, Katsufumi Uchiyama & Masashi Takaso

  2. Department of Orthopaedic Surgery, Kitasato University Medical Center, 6-100 Arai, Kitamoto, Saitama, 364-8501, Japan

    Yojiro Minegishi

  3. Department of Microbiology, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan

    Masaki Nakamura

Authors
  1. Shinsuke Ikeda
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  2. Katsufumi Uchiyama
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  4. Masaki Nakamura
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  5. Masashi Takaso
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Katsufumi Uchiyama, Yojiro Minegishi, and Shinsuke Ikeda. The first draft of the manuscript was written by Shinsuke Ikeda and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shinsuke Ikeda.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Kitasato University Medical Ethics Organization, KMEO B16-68) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

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Ikeda, S., Uchiyama, K., Minegishi, Y. et al. Evaluation of myeloperoxidase in synovial fluid as a biomarker for chronic periprosthetic joint infection. International Orthopaedics (SICOT) 44, 1915–1920 (2020). https://doi.org/10.1007/s00264-020-04753-0

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  • DOI: https://doi.org/10.1007/s00264-020-04753-0

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