Abstract:
BACKGROUND:Periprosthetic joint infection (PJI) following total joint arthroplasty is a serious complication that causes severe morbidity and adds a major financial burden to the healthcare system. Although there is plenty of research on the alpha-defensin (AD) test, a meta-analysis consisting of only prospective studies investigating AD's diagnostic efficacy has not been performed. Additionally, some important subgroups such as THA and TKA have not been separately analyzed, particularly regarding two commonly used versions of the AD test, the laboratory-based (ELISA) and lateral-flow (LF). QUESTIONS/PURPOSES:(1) Does the AD ELISA test perform better in the detection of PJI than the AD LF test, in terms of pooled sensitivity and specificity, when including prospective studies only? (2) Are there differences in sensitivity or specificity when using AD ELISA and AD LF tests for PJI diagnosis of THA or TKA PJI separately? METHODS:Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we included prospective studies describing the use of either AD test in the workup of pain after total joint arthroplasty (primary or revision, but not after resection arthroplasty). Fifteen studies (AD ELISA: 4; AD LF: 11) were included, with 1592 procedures. Subgroup data on THA and TKA could be retrieved for 1163 procedures (ELISA THA: 123; LF THA: 257; ELISA TKA: 228; LF TKA: 555). Studies not describing THA or TKA, those not using Musculoskeletal Infection Society (MSIS) criteria as the standard for determining the presence or absence of PJI, those not clearly reporting data for the AD test for the total cohort, and those describing data published in another study were excluded. Studies were not excluded based on follow-up duration; the MSIS criteria could be used within a few weeks, when test results were available. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 criteria. Study quality was generally good. The most frequent sources of bias were related to patient selection (such as unclear inclusion and exclusion criteria) and flow and timing (uncertainty in place and time of aspiration, for example). Heterogeneity was moderate to high; a bivariate random-effects model therefore was used. To answer both research questions, sensitivity and specificity were calculated for AD ELISA and LF test groups and THA and TKA subgroups, and were compared using z-test statistics and meta-regression analysis. RESULTS:No differences were found between the AD ELISA and the AD LF for PJI diagnosis in the pooled cohorts (THA and TKA combined), in terms of sensitivity (90% versus 86%; p = 0.43) and specificity (97% versus 96%; p = 0.39). Differences in sensitivity for PJI diagnosis were found between the THA and TKA groups for the AD ELISA test (70% versus 94%; p = 0.008); pooled AD LF test sensitivity did not differ between THA and TKA (80% versus 87%; p = 0.20). No differences in specificity were found in either subgroup. CONCLUSIONS:Both the AD ELISA and AD LF test can be used in clinical practice because both have high sensitivity and very high specificity for PJI diagnosis. The lower sensitivity found for diagnosis of PJI in THA for the AD ELISA test must be carefully interpreted because the pooled data were heterogenous and only two studies for this group were included. Future research should analyze TKAs and THAs separately to confirm or disprove this finding. LEVEL OF EVIDENCE:Level II diagnostic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Kuiper JWP,Verberne SJ,Vos SJ,van Egmond PWdoi
10.1097/CORR.0000000000001225subject
Has Abstractpub_date
2020-06-01 00:00:00pages
1333-1344issue
6eissn
0009-921Xissn
1528-1132pii
00003086-202006000-00030journal_volume
478pub_type
杂志文章abstract:BACKGROUND:Numerous studies indicate highly crosslinked polyethylenes reduce the wear debris volume generated by hip arthroplasty acetabular liners. This, in turns, requires new methods to isolate and characterize them. QUESTIONS/PURPOSES:We describe a method for extracting polyethylene wear particles from bovine seru...
journal_title:Clinical orthopaedics and related research
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abstract::The objective of this study was to reconstruct full thickness cartilage defects in rabbit knees with in vitro engineered cartilage tissue based on noncryopreserved and cryopreserved chondrocytes in polymer fleece scaffolds. Osteochondral defects in rabbits were filled with polymer cylinders with noncryopreserved or cr...
journal_title:Clinical orthopaedics and related research
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abstract::Osteochondral autografts of femoral condyles in dogs were frozen at different cooling velocities after exposure to either glycerol or dimethyl sulfoxide to determine the freezing regimen best suited for preservation of intact cartilage. Autografts were also subjected to hypothermic storage in tissue culture media for ...
journal_title:Clinical orthopaedics and related research
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更新日期:1985-07-01 00:00:00
abstract::The efficiency of ultraviolet light and fluorescence macrophotography in screening various tissues of the locomotor system was tested on 46 human and 43 animal specimens from surgical, experimental and autopsy material, examined as living tissues during operation, or as fresh, frozen or fixed specimens. After visual e...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
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abstract::The authors retrospectively reviewed 29 hip and 13 knee arthroplasties performed in 17 adolescents and young adults from 1973 through 1979. Most patients had severe multiple joint involvement; 16 had juvenile rheumatoid arthritis. Clinical and roentgenographic evaluations were performed before operation and at routine...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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doi:10.1007/s11999-014-3934-x
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-11-01 00:00:00
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
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-010-1303-y
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abstract::Sixty-four total articular replacement arthroplasties were performed in 60 patients with an average follow-up period of 24 months. Ninety-three percent of the patients had little or no pain at the time of follow-up examination; 83% of the patients were able to walk unlimited distances; 97% of the patients had a postop...
journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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doi:
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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abstract::The histology, histochemistry, and ultrastructure were investigated in 12 ligamentum teres and 11 hip joint capsule biopsies obtained at open reduction of 9 patients with congenital dislocation of the hip (CDH) and of 2 normal hips. The ages of the patients ranged from 2 months to 4 years and 2 months. In the joint ca...
journal_title:Clinical orthopaedics and related research
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doi:
更新日期:1980-01-01 00:00:00
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abstract::Rigid body mechanics with computer data acquisition and analysis techniques were used to determine the three-dimensional motions of any point on the tibial component of a total knee arthroplasty. Three stem configurations were compared: (1) no stem; (2) short stem (40 mm); and (3) long stem (75 mm). In addition, three...
journal_title:Clinical orthopaedics and related research
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更新日期:1997-12-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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journal_title:Clinical orthopaedics and related research
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更新日期:1980-05-01 00:00:00
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更新日期:2013-07-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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