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Leukocyte esterase test and alpha-defensin test have similar accuracy for the diagnosis of periprosthetic joint infection

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Abstract

Background

The diagnosis of periprosthetic joint infection (PJI) after total joint replacement remains challenging. Synovial biomarkers are recommended as the major diagnostic criteria for PJI. The purpose of this study was to test the accuracy of the alpha-defensin test and compare it with that of the leukocyte esterase (LE) test for the diagnosis of PJI.

Methods

We obtained 130 hip or knee aspirates from May 2015 to September 2018. PJI was defined according to the European Bone and Joint Infection Society (EBJIS) criteria. Synovial fluid samples were tested with the alpha-defensin ELISA and a LE strip. For the LE strip test, besides using the traditional threshold 500 (equal to ++), we are also using an improved one, with 500 (equal to ++) serving as the threshold for the tests before centrifugation and both 250 and 500 indicating positive results after centrifugation. The receiver operating characteristic (ROC) curves, sensitivity, specificity, positive predictive value, negative predictive value, and Cohen’s Kappa value were calculated for the LE and alpha-defensin tests.

Results

The area under the curve (AUC) of alpha-defensin, LE strip test with traditional, and improved interpretation strategy were 0.875, 0.854, and 0.877, respectively. The Cohen’s Kappa value for the alpha-defensin tests was 0.826 with the traditional LE interpretation strategy and 0.875 with the improved strategy.

Conclusion

The present study shows that the use of the LE strip to test synovial fluid yielded an accuracy similar to that of the alpha-defensin immunoassay for the diagnosis of PJI; this finding supports the 2018 ICM PJI definition, which considers positive alpha-defensin and LE test results to be equivalent.

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Acknowledgments

The authors would like to thank all staff from the participating departments and clinics.

Funding

This project was supported by grants from the Military Medical and Health Achievements Expansion Project (19WKS09).

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Authors and Affiliations

  1. Department of Orthopaedics, Chinese PLA General Hospital (301 Hospital), 28 Fuxing Rd., Beijing, 100853, People’s Republic of China

    Bao-Zhan Yu, Rui Li, Jun Fu, Wei Chai, Li-Bo Hao & Ji-Ying Chen

  2. Department of Orthopaedics, Bao Ding Gem Flower Eastern Hospital, Bao Ding, Hebei, People’s Republic of China

    Bao-Zhan Yu

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  1. Bao-Zhan Yu
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Correspondence to Rui Li or Ji-Ying Chen.

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Yu, BZ., Li, R., Fu, J. et al. Leukocyte esterase test and alpha-defensin test have similar accuracy for the diagnosis of periprosthetic joint infection. International Orthopaedics (SICOT) 45, 1677–1682 (2021). https://doi.org/10.1007/s00264-020-04903-4

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  • DOI: https://doi.org/10.1007/s00264-020-04903-4

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