Synovial fluid α-defensin in the diagnosis of periprosthetic joint infection: The lateral flow test is an effective intraoperative detection method

Abstract

Background: Synovial fluid α-defensin is a valuable biomarker for periprosthetic joint infection (PJI). Its diagnostic value for PJI has been widely evaluated recently, but results are inconsistent, especially for different test methods. The objective of this study was to evaluate the diagnostic value of laboratory-based immunoassay and lateral flow testing for the detection of α-defensin against hip and knee PJI. Methods: We systematically searched MEDLINE and EMBASE for articles on the diagnostic accuracy of α-defensin for PJI published up to September 2018. The pooled sensitivity, specificity, area under the curve (AUC), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated for the evaluation of the diagnostic value of α-defensin for PJI. Results: Nineteen studies were included. Eleven evaluated laboratory-based immunoassay, and 10 evaluated the lateral flow test results. The pooled sensitivity, specificity, AUC, PLR, NLR, and DOR of laboratory-based immunoassays were 0.96 (95% confidence interval [CI] 0.90-0.98), 0.97 (95% CI 0.95-0.99), 0.99 (95% CI 0.98-1.00), 35.0 (95% CI 18.5-66.2), 0.04 (95% CI 0.02-0.11), and 811 (95% CI 220-2990), respectively. The pooled sensitivity, specificity, AUC, PLR, NLR, and DOR of the lateral flow test were 0.86 (95% CI 0.81-0.91), 0.96 (95% CI 0.93-0.98), 0.95 (95% CI 0.93-0.97), 21.2 (95% CI 11.7-38.5), 0.14 (95% CI 0.10-0.21), and 148 (95% CI 64-343), respectively. Conclusions: Laboratory-based immunoassay of α-defensin is highly accurate for the diagnosis of hip and knee PJI. The lateral flow test is less sensitive but still a useful intraoperative detection tool for PJI.