Kuiper JW, Pander P, Vos SJ. Good accuracy of the alpha-defensin lateral flow test for hip periprosthetic joint infection: A pilot study in a retrospective cohort of 52 patients. World J Orthop 2020; 11(1): 36-46 [PMID: 31966968 DOI: 10.5312/wjo.v11.i1.36]
Corresponding Author of This Article
Jesse WP Kuiper, MD, MSc, Department of Orthopedic Surgery, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, Alkmaar 1815 JD, Netherlands. jwp.kuiper@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Positive histological analysis of periprosthetic tissue;
A single positive culture.
Table 2 European Bone and Joint Infection Society criteria for periprosthetic joint infection definition. One or more criteria fulfilled means positive periprosthetic joint infection diagnosis[4]
Sinus tract OR purulence around the prosthesis;
Acute inflammation on histopathology of periprosthetic tissue;
Elevated synovial fluid white blood cell count of more than 2.000 cells/μL OR elevated synovial fluid polymorphonuclear neutrophil percentage (PMN%) > 70%;
Microbial growth in synovial fluid OR > 2 tissue samples (for highly virulent microorganisms already one positive sample confirms infection) OR sonication fluid (≥ 50 CFU/mL).
Table 3 New 2018 International Consensus Meeting scoring criteria for periprosthetic joint infectiondefinition[5]: Major criteria (at least one of the following)
Two positive cultures of the same organism
Infected
Sinus tract with evidence of communication to the joint or visualization of the prosthesis
Table 4 New 2018 International Consensus Meeting scoring criteria for periprosthetic joint infection definition[5]: Preoperative diagnosis
≥ 6: Infected; 4-5: Inconclusive; 0-3: Not infected
Positive histology
3
Positive purulence
3
Single positive culture
2
Table 6 Demographics of the described cohort and the group of excluded patients (no alpha-defensin lateral flow test performed)
Cohort
Excluded
Total (n)
52
31
Age [mean (SD), yr]
72 (9.2)
67.5 (9.5)
Gender (n)
Male
24
12
Female
28
19
Operated side (n)
Right
28
12
Left
24
19
Prosthesis (n)
Total hip arthroplasty
46
26
Hemi-arthroplasty
6
5
Articulation (n)
MoP
31
18
CoP
8
4
CoC
4
3
MoM
3
1
HA
6
5
Time to aspiration [Median (range), mo]
35 (3-266)
32.4 (3-191)
Table 7 Characteristics of all patients with positive alpha-defensin lateral flow test and/or positive or inconclusive criteria
Case
Criteria
A
B
C
D
E
F
G
H
I
PJI?
Art
Sinus tract
Visible purulence
CRP (mg/ L)
ESR (mm/h)
WBC count (cells/μL)
PMN%
Culture synovial fluid (nr of cultures)
Culture tissue (nr of cultures)
AD
MSIS (+/-; criteria)
EBJIS (+/-; criteria)
2018 ICM (+/-/i; criteria)
Revision surgery
1- or 2-stage
1
CoC
-
-
6.5
21.0
19100
91
neg (1)
neg (6)
+
-
E,F
+
E,F
+
E,F,I
Yes
2-stage
2
MoP
Yes
-
9.0
23.0
-
-
pos (2)
pos (8/9)
+
+
A,G,H
+
A,G,H
+
A,G,H,I
Yes
2-stage
3
MoP
-
-
8.5
29.0
3000
4
neg (2)
-
-
-
+
E
-
No
-
4
MoP
-
-
9.8
16.0
6200
77
neg (2)
pos (5/8)
+
+
E,H
+
E,F,H
+
E,H,I
Yes
2-stage
5
CoC
-
-
6.9
10.0
2300
-
neg (1)
-
-
-
+
E
-
No
-
6
MoP
-
-
12.0
26.0
10
-
neg (2)
pos (1/2)
-
-
C,H
-
i
C,H
Yes
1-stage
7
MoP
-
-
-
-
9350
-
neg (1)
-
-
-
E
+
E
-
E
No
-
8
HA
-
-
-
-
-
-
neg (1)
pos (1/6)
+
-
H
-
i
H,I
Yes
1-stage
9
MoP
-
-
144.0
64.0
37300
92
pos (1/2)
pos (2/6)
+
+
C,D,E,F,G,H
+
E,F,G,H
+
C,D,E,F,H,I
Yes
DAIR
10
MoP
-
-
61.0
72.0
7900
95
pos (1/1)
pos (9/9)
+
+
C,D,E,F,G,H
+
E,F,G,H
+
C,D,E,F,H,I
Yes
2-stage
11
MoP
-
-
71.0
55.0
35300
97
pos (2/2)
pos (7/7)
+
+
C,D,E,F,G,H
+
E,F,G,H
+
C,D,E,F,H,I
Yes
2-stage
12
HA
-
-
9.6
-
4900
81
-
-
+
-
E,F
+
E,F
+
E,F,I
No
-
13
MoM
-
Yes
195.0
-
264000
96
neg (2)
-
+
+
B,C,E,F
+
B,E,F
+
B,C,E,F,I
No
-
14
MoP
-
-
15.0
13.0
8000
-
neg (1)
neg (6)
+
-
C,E
+
E
+
C,E,I
Yes
2-stage
15
HA
-
-
1.0
9.0
4000
15
neg (2)
-
-
-
E
+
E
-
E
No
-
16
MoM
-
-
5.7
8.0
5170
52
neg (3)
-
+
-
E
+
E
+
E,I
No
-
Table 8 All cases of positive cultures in the described cohort
Case
Culture after aspiration (positive cultures/nr of total cultures)
Culture after revision (positive cultures/nr of total cultures)
2
Propionibacterium acnes (2/2)
Cutibacterium acnes (8/9)
Staphylococcus aureus (1/2)
4
Negative (2/2)
Staphylococcus capitis (5/8)
Staphyloccus hominis (1/8)
Staphylococcus epidermidis (1/8)
Propionibacterium acnes (1/8)
7
Negative (2/2)
Propionibacterium acnes (1/2)
8
Negative (1/1)
Staphylococcus capitis (1/6)
9
Staphylococcus aureus (1/2)
Staphylococcus aureus (2/6)
10
Pseudomonas aeruginosa (1/1)
Pseudomonas aeruginosa (9/9)
Staphylococcus epidermidis (1/9)
13
Staphylococcus lugdunensis (2/2)
Staphylococcus lugdunensis (7/7)
Citation: Kuiper JW, Pander P, Vos SJ. Good accuracy of the alpha-defensin lateral flow test for hip periprosthetic joint infection: A pilot study in a retrospective cohort of 52 patients. World J Orthop 2020; 11(1): 36-46