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The Diagnostic Utility of Synovial Fluid Markers in Periprosthetic Joint Infection: A Systematic Review and Meta-analysis

Saleh, Anas MD; Ramanathan, Deepak MD; Siqueira, Marcelo Bogliolo P. MD; Klika, Alison K. MS; Barsoum, Wael K. MD; Rueda, Carlos A. Higuera MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: November 2017 - Volume 25 - Issue 11 - p 763–772
doi: 10.5435/JAAOS-D-16-00548
Research Article
SDC

Introduction: This study is a systematic review of all reported synovial fluid markers for the diagnosis of periprosthetic joint infection and a meta-analysis of the most frequently reported markers to identify those of greatest diagnostic utility.

Methods: A search of six databases was conducted to identify all studies evaluating the utility of synovial fluid markers in the diagnosis of periprosthetic joint infection. Two observers assessed methodologic quality and extracted data independently. A meta-analysis of the most frequently reported markers was performed.

Results: Twenty-three studies were included in the meta-analysis. The most common markers (and their respective area under the curve) were interleukin-17 (0.974), leukocyte esterase (0.968), α-defensin (0.958), interleukin-6 (0.956), interleukin-1β (0.948), and C-reactive protein (0.927). Among these markers, α-defensin had the highest diagnostic odds ratio but did not achieve statistically significant superiority.

Conclusion: The most frequently studied synovial fluid markers for the diagnosis of periprosthetic joint infection are C-reactive protein, leukocyte esterase, interleukin-6, interleukin-1β, α-defensin, and interleukin-17, all of which have high diagnostic utility.

Level of Evidence: Level II

From the Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH.

Correspondence to Dr. Saleh: anas.ar.saleh@gmail.com.

Dr. Barsoum or an immediate family member has received royalties from Exactech, Stryker, and Zimmer Biomet; is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker; serves as a paid consultant to or is an employee of Stryker; has stock or stock options held in Custom Orthopaedic Solutions, iVHR, and Stryker; has received research or institutional support from Active Implants, CoolSystems, DJO Global, OrthoSensor, Stryker, and Zimmer Biomet; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from KEF Health; and serves as a board member, owner, officer, or committee member of KEF Health. Dr. Rueda or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of ConvaTec; serves as a paid consultant to or is an employee of KCI, Pfizer, and Zimmer Biomet; has received research or institutional support from CD Diagnostics, Cempra, CyMedica, KCI, Myoscience, the Orthopaedic Research and Education Foundation , Orthofix, Pacira Pharmaceuticals, and Stryker; and serves as a board member, owner, officer, or committee member of the American Association of Hip and Knee Surgeons, the Musculoskeletal Infection Society, the National Quality Forum, and the Academy of Medicine of Cleveland & Northern Ohio. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Saleh, Dr. Ramanathan, Dr. Siqueira, and Ms. Klika.

Received July 19, 2016

Accepted March 15, 2017

© 2017 by American Academy of Orthopaedic Surgeons
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