Abstract:
BACKGROUND:The alpha-defensin test has been previously demonstrated to be highly accurate in the diagnosis of prosthetic joint infection (PJI), nearly matching the Musculoskeletal Infection Society definition for PJI. However, the relationship between alpha-defensin levels and differing infecting organism has not yet been investigated. QUESTIONS/PURPOSES:The purpose of this study is to describe the breadth of organisms that can trigger a positive synovial fluid alpha-defensin test result in the setting of PJI and also to assess the magnitude of the alpha-defensin result in terms of various pathogen characteristics. METHODS:Between December 2012 and March 2014, one laboratory processed 2319 synovial fluid samples for alpha-defensin testing. The present study reviewed the results of the 1937 samples that simultaneously had a synovial fluid culture performed; these came from 418 surgeons in 42 states. The overall culture-positive rate was 49% (244 of 498) among alpha-defensin-positive synovial fluids and 1% (19 of 1439) among alpha-defensin-negative synovial fluids. The organisms recovered from 244 alpha-defensin-positive, culture-positive fluids were recorded and grouped based on various characteristics, including Gram type, species, virulence, oral pathogenicity, and source joint. Alpha-defensin-negative samples served as uninfected controls. Median alpha-defensin levels were calculated for each group, and Dunn's multiple comparison test for nonparametric data was used to identify any statistically significant (p < 0.05) organism-specific differences in the alpha-defensin level. RESULTS:The alpha-defensin test for PJI was positive in the setting of a wide spectrum of organisms typically causing PJI. The median alpha-defensin level for all 244 alpha-defensin-positive, culture-positive samples (4.7 [interquartile range {IQR}, 3.7-5.3]) was higher than negative controls (0.26 [IQR, 0.22-0.33]) with a median difference of 4.4 (p < 0.001). There were no differences in the median alpha-defensin levels when performing a multiple comparison test among Gram-positive organisms (4.7 [IQR, 3.6-5.3]), Gram-negative organisms (4.8 [IQR, 4.2-5.3]), yeast (4.1 [IQR, 2.2-5.1]), virulent organisms (4.7 [IQR, 3.8-5.2]), less virulent organisms (4.8 [IQR, 3.6-5.4]), oral pathogens (4.5 [IQR, 3.2-5.2]), knees (4.7 [IQR, 3.7-5.3]), hips (4.9 [IQR, 4.1-5.8]), or shoulders (5.3 [IQR, 4.0-10.7]) with all comparisons having a p > 0.999. CONCLUSIONS:The alpha-defensin test provides consistent results regardless of the organism type, Gram type, species, or virulence of the organism and should be seriously considered to be a standard diagnostic tool in the evaluation for PJI. Future research should focus on the performance of this test in specific clinical scenarios such as the immediate postoperative period in the setting of severe immunocompromise and in the setting of a native joint. LEVEL OF EVIDENCE:Level III, diagnostic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Deirmengian C,Kardos K,Kilmartin P,Gulati S,Citrano P,Booth RE Jrdoi
10.1007/s11999-015-4152-xsubject
Has Abstractpub_date
2015-07-01 00:00:00pages
2229-35issue
7eissn
0009-921Xissn
1528-1132journal_volume
473pub_type
杂志文章abstract::In experiments involving disuse osteoporosis induced by plaster cast immobilization, 2 commonly used commercial feeds (Wayne Lab Blox and Purina Laboratory Chow) gave different results. Preliminary evidence suggests that this dichotomy of results is due to an interaction between metabolic changes caused by physiologic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract::The primary indication for arthroplasty of the hip is the elimination of pain and the restoration of function. This paper addresses the progression of developments leading to the present satisfactory attainment of this goal. Having achieved this goal, patients and surgeons have come to expect far more than the necessi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1985-11-01 00:00:00
abstract::Heat shock proteins (HSPs) are often upregulated following oxidative and other forms of stress. Based on reports of excessive apoptosis in torn supraspinatus tendon and mechanically loaded tendon cells, we hypothesized heat shock proteins may be present in rodent and human models of tendinopathy due to their central r...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0265-9
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abstract:BACKGROUND:Large-head metal-on-metal (MoM) hip arthroplasties have demonstrated poor survival. Damage at the taper-trunnion junction is a contributing factor; however, the influence of junction design is not well understood. QUESTIONS/PURPOSES:(1) Does taper type affect fretting, corrosion, and volumetric wear at the ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3115-3
更新日期:2014-02-01 00:00:00
abstract::The skeletal dysplasias are a large and heterogeneous group of disorders. Currently, there are more than 100 recognized forms of skeletal dysplasia, which makes arriving at a specific diagnosis difficult. This process is additionally complicated by the rarity of the individual conditions. The establishment of a precis...
journal_title:Clinical orthopaedics and related research
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doi:10.1097/00003086-200208000-00006
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abstract::The design of the Boston thoracolumbosacral orthosis for scoliosis treatment may increase intragastric pressure, possibly causing reflux esophagitis. Early recognition and aggressive medical treatment of reflux may avoid esophagitis and the need to either abandon or modify conservative scoliosis management. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-09-01 00:00:00
abstract::Postoperative infection of elective surgical wounds with Clostridium species has been linked to gastrointestinal tract lesions. A 55-year-old man with a history of peptic ulcer disease was treated by open reduction and internal fixation with autogeneic cancellous bone grafting from an anterior iliac crest donor site f...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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更新日期:1993-08-01 00:00:00
abstract:BACKGROUND:Wound closure accounts for a relatively constant portion of the time required to complete a surgical case. Both longer closure times and wound infections contribute to higher medical costs and patient morbidity. QUESTIONS/PURPOSES:We therefore determined whether (1) biologic and treatment factors greater in...
journal_title:Clinical orthopaedics and related research
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doi:10.1007/s11999-012-2524-z
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abstract::Isolated bovine growth plate chondrocytes suspended in a synthetic cartilage buffer containing 10(-7) to 10(-3) M concentrations of calcium were treated with 1 microM ionomycin to induce changes in intracellular ionized calcium as measured by Fura-2 fluorescence. An increase in intracellular calcium of 10(-6) to 10(-4...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract::The vascular anatomy of the distal radius and ulna is complex with a series of longitudinal vessels anastomosing with a series of arches. This complex anastomotic network of vessels has a consistent spatial relationship to surrounding anatomic structures and is constant in nature. Knowledge of the vascular anatomy of ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200102000-00009
更新日期:2001-02-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199809000-00014
更新日期:1998-09-01 00:00:00
abstract::The mainstay of local control of primary bone malignancies in the skeletally immature has been amputation or, in selected cases, rotationplasty. The development of expandable endoprostheses has permitted an alternative approach for local control in the growing child. Between January 1985 and December 1987, 12 skeletal...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract::Although femoral shaft fractures constitute fewer than 2% of all fractures in children and adolescents, their treatment has produced many pieces of literature and years of controversy. Prevailing opinion has favored nonoperative and operative treatment, and a variety of techniques have been advocated to avoid complica...
journal_title:Clinical orthopaedics and related research
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更新日期:2005-05-01 00:00:00
abstract::Periostitis in the athlete is a common overuse clinical entity often found in the lower extremity. An analogous overuse syndrome also may occur in the upper extremity. These 2 case reports describe the history, physical findings, radiographic changes, and treatment for periostitis of the upper extremity rarely seen in...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Metal-on-metal (MOM) THA bearing technology has focused on improving the arc of motion and stability and minimizing wear compared with traditional metal-on-polyethylene (MOP) bearing couples. It is unclear whether this more costly technology adds value in terms of improved implant survival. QUESTIONS/PURPOS...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-2821-1
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abstract::Achondroplastic patients having lengthening surgery of the lower limbs were preoperatively evaluated from psychologic, functional, vascular, and endocrinometabolic points of view. Long-term research is required to determine effects of surgical correction of achondroplasia from both psychologic and various physical poi...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 00:00:00
abstract::In 37 of 43 cases (86%) the late results of fasciotomy for chronic lateral epicondylitis were excellent or good. The initial result was maintained for an average of 8.0 years. The procedure is simple and morbidity is minimal. Patient selection and technical factors appeared to account for the failures. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-09-01 00:00:00
abstract::A study of 281 patients evaluated for a meniscus pathologic condition was performed to assess the accuracy of the clinical diagnosis and arthrogram and delineate the role of arthroscopy. Following the clinical examination, the surgeon stated his level of confidence in his diagnosis, as did the radiologist in his inter...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1982-03-01 00:00:00
abstract::This study focused on evaluating the impact of the adolescent growth spurt on the onset of idiopathic scoliosis. A total of 698 students (362 girls and 336 boys aged nine to 12 years) were followed for three years to study their growth in the pubertal period and changes in spinal status. Every six months measurements ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-09-01 00:00:00
abstract::A retrospective clinical review of 100 consecutive patients with extremity sarcomas managed by limb salvage operations was performed to evaluate local tumor control and morbidity. The mean follow-up period was 45.1 months. Overall survival was 86%. There were local recurrences in 3% of patients, and 26 complications i...
journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1990-11-01 00:00:00
abstract::Thirteen insufficiency stress fractures of the femoral neck in 13 elderly patients (average age, 82 years) were studied retrospectively. All occurred in Caucasian women with severe osteoporosis. A vague pain about the hip, of spontaneous onset, was the main symptom on first visit. The diagnosis was delayed in most cas...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-07-01 00:00:00
abstract::Progressive loss of hip containment attributable to dysplasia epiphysealis hemimelica of the right proximal femur and macrodactyly of the right second toe was diagnosed and monitored by radiographs and magnetic resonance imaging in a 7-year-old boy. The patient had early surgical correction including shortening osteot...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
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abstract::Hyperbaric oxygen has been shown to promote healing in bone and some soft tissues. This study was undertaken to determine its effect on ligamentous healing. Forty-eight Sprague-Dawley rats underwent a standardized surgical laceration of the right (divided) medial collateral ligament, whereas the left (undivided) media...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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abstract::Except in emergencies, the physician's obligation is not to relieve pain, but to diagnose and treat pathology. Psychological factors complicate organic pain, and make the diagnosis of "psychogenic" pain virtually impossible on the basis of psychological tests alone. In acute (short-term) pain, anti-anxiety agents are ...
journal_title:Clinical orthopaedics and related research
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doi:10.1097/00003086-197711000-00017
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abstract::Ten cases of loosening of the femoral component following a Charnley total hip replacement were noted in a series of 160 patients. In 3 patients, the femoral component bent without fracturing. All of the patients were overweight. Loosening occurred despite the fact that the femoral component was in a valgus position i...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
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abstract::A stress fracture occurred in a 19-year-old competitive tennis player. Stress fractures are one of the more common problems occurring in vigorous sports. Prevalence, location, and treatment have been well documented, especially in the lower extremity. Stress fractures of the upper extremities are uncommon. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1986-08-01 00:00:00
abstract::Progressive heterotopic ossification leads to ankylosis of the major joints in patients who have fibrodysplasia ossificans progressiva. Joint subluxation has not been recognized widely in patients with this disease. The clinical records and radiographs of 79 patients with fibrodysplasia ossificans progressiva were rev...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00
abstract::To address the issue of nonunion with trochanteric osteotomy, surgeons have experimented with various modes of fixation, wire and cable being the two most popular. From a group of 643 primary cemented total hip arthroplasties performed by a single surgeon via the trans-trochanteric approach, minimum four-year roentgen...
journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1992-12-01 00:00:00
abstract::In adults, when flexor tendons cannot be repaired until weeks or months after injury or when tendons have ruptured and part of the tendon is nonviable, it is often inadvisable to suture the tendon ends together. When a primary repair has failed, when there has been a delay in tendon reconstruction to allow skin covera...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
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