Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review
Objective The current diagnostic criteria for periprosthetic joint infection (PJI) are diverse and controversial, leading to delayed diagnosis. This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage....
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-11-01
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| Series: | Orthopaedic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/os.13500 |
| _version_ | 1797991443455803392 |
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| author | Haozheng Tang Jialian Xu Wei'en Yuan You Wang Bing Yue Xinhua Qu |
| author_facet | Haozheng Tang Jialian Xu Wei'en Yuan You Wang Bing Yue Xinhua Qu |
| author_sort | Haozheng Tang |
| collection | DOAJ |
| description | Objective The current diagnostic criteria for periprosthetic joint infection (PJI) are diverse and controversial, leading to delayed diagnosis. This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage. Methods We searched the MEDLINE and Embase databases for retrospective or prospective studies which reported preoperative‐available assays (serum, synovial, or culture tests) for the diagnosis of chronic PJI among inflammatory arthritis (IA) or non‐IA populations from January 1, 2000 to June 30, 2022. Threshold effective analysis was performed on synovial polymorphonuclear neutrophils (PMN%), synovial white blood cell (WBC), serum C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to find the relevant cut‐offs. Results Two hundred and sixteen studies and information from 45,316 individuals were included in the final analysis. Synovial laboratory‐based α‐defensin and calprotectin had the best comprehensive sensitivity (0.91 [0.86–0.94], 0.95 [0.88–0.98]) and specificity (0.96 [0.94‐0.97], 0.95 [0.89–0.98]) values. According to the threshold effect analysis, the recommended cut‐offs are 70% (sensitivity 0.89 [0.85–0.92], specificity 0.90 [0.87–0.93]), 4100/μL (sensitivity 0.90 [0.87–0.93], specificity 0.97 [0.93–0.98]), 13.5 mg/L (sensitivity 0.84 [0.78–0.89], specificity 0.83 [0.73–0.89]), and 30 mm/h (sensitivity 0.79 [0.74–0.83], specificity 0.78 [0.72–0.83]) for synovial PMN%, synovial WBC, serum CRP, and ESR, respectively, and tests seem to be more reliable among non‐IA patients. Conclusions The laboratory‐based synovial α‐defensin and synovial calprotectin are the two best independent preoperative diagnostic tests for PJI. A cut off of 70% for synovial PMN% and tighter cut‐offs for synovial WBC and serum CRP could have a better diagnostic accuracy for non‐IA patients with chronic PJI. |
| first_indexed | 2024-04-11T08:52:19Z |
| format | Article |
| id | doaj.art-cd6b48525f4d41d88be93a18cb072360 |
| institution | Directory Open Access Journal |
| issn | 1757-7853 1757-7861 |
| language | English |
| last_indexed | 2024-04-11T08:52:19Z |
| publishDate | 2022-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Orthopaedic Surgery |
| spelling | doaj.art-cd6b48525f4d41d88be93a18cb0723602022-12-22T04:33:33ZengWileyOrthopaedic Surgery1757-78531757-78612022-11-0114112822283610.1111/os.13500Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic ReviewHaozheng Tang0Jialian Xu1Wei'en Yuan2You Wang3Bing Yue4Xinhua Qu5Department of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai ChinaMinistry of Education Engineering Research Center of Cell & Therapeutic Antibody School of Pharmacy, Shanghai Jiao Tong University Shanghai ChinaDepartment of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine Shanghai ChinaObjective The current diagnostic criteria for periprosthetic joint infection (PJI) are diverse and controversial, leading to delayed diagnosis. This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage. Methods We searched the MEDLINE and Embase databases for retrospective or prospective studies which reported preoperative‐available assays (serum, synovial, or culture tests) for the diagnosis of chronic PJI among inflammatory arthritis (IA) or non‐IA populations from January 1, 2000 to June 30, 2022. Threshold effective analysis was performed on synovial polymorphonuclear neutrophils (PMN%), synovial white blood cell (WBC), serum C‐reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to find the relevant cut‐offs. Results Two hundred and sixteen studies and information from 45,316 individuals were included in the final analysis. Synovial laboratory‐based α‐defensin and calprotectin had the best comprehensive sensitivity (0.91 [0.86–0.94], 0.95 [0.88–0.98]) and specificity (0.96 [0.94‐0.97], 0.95 [0.89–0.98]) values. According to the threshold effect analysis, the recommended cut‐offs are 70% (sensitivity 0.89 [0.85–0.92], specificity 0.90 [0.87–0.93]), 4100/μL (sensitivity 0.90 [0.87–0.93], specificity 0.97 [0.93–0.98]), 13.5 mg/L (sensitivity 0.84 [0.78–0.89], specificity 0.83 [0.73–0.89]), and 30 mm/h (sensitivity 0.79 [0.74–0.83], specificity 0.78 [0.72–0.83]) for synovial PMN%, synovial WBC, serum CRP, and ESR, respectively, and tests seem to be more reliable among non‐IA patients. Conclusions The laboratory‐based synovial α‐defensin and synovial calprotectin are the two best independent preoperative diagnostic tests for PJI. A cut off of 70% for synovial PMN% and tighter cut‐offs for synovial WBC and serum CRP could have a better diagnostic accuracy for non‐IA patients with chronic PJI.https://doi.org/10.1111/os.13500DiagnosisMeta‐analysisPeriprosthetic joint infectionSerum and synovial testThreshold effectTotal joint arthroplasty |
| spellingShingle | Haozheng Tang Jialian Xu Wei'en Yuan You Wang Bing Yue Xinhua Qu Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review Orthopaedic Surgery Diagnosis Meta‐analysis Periprosthetic joint infection Serum and synovial test Threshold effect Total joint arthroplasty |
| title | Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review |
| title_full | Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review |
| title_fullStr | Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review |
| title_full_unstemmed | Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review |
| title_short | Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non‐Inflammatory Arthritis Periprosthetic Joint Infection: A Meta‐analysis and Systematic Review |
| title_sort | reliable diagnostic tests and thresholds for preoperative diagnosis of non inflammatory arthritis periprosthetic joint infection a meta analysis and systematic review |
| topic | Diagnosis Meta‐analysis Periprosthetic joint infection Serum and synovial test Threshold effect Total joint arthroplasty |
| url | https://doi.org/10.1111/os.13500 |
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