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Alpha-defensin
69%
2190/3161
Intraoperative frozen section
9%
274/3161
Serum interleukin-6 (IL-6)
8%
243/3161
C-reactive protein (CRP)
11%
361/3161
Leukocyte esterase (LE) colorimetric strip test
2%
73/3161
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Synovial alpha-defensin has been shown to be 100% sensitive and 98% specific for periprosthetic joint infections. The other answers can aid in the diagnosis of a periprosthetic joint infection (PJI), however, they do not have higher sensitivity and specificity as alpha-defensin. The 2018 definition is the most established predictive clinical tool for the diagnosis of PJI. While WBC, ESR, and CRP are included in the criteria, these are all nonspecific markers of inflammation. Inflammatory markers such as CRP, while highly sensitive, can be affected by renal clearance. The LE strip test is more specific (97-100%) but with only a cited 69-81% sensitivity. Alpha defensin is an antimicrobial peptide produced by neutrophils in synovial fluid, with levels greater than 5.2mg/L being cited as 100% sensitive AND specific for infection. Wyatt et al. performed a systematic review investigating the efficacy of alpha defensin and LE strip test as biomarkers for PJI. The authors found that alpha-defensin had a pooled diagnostic sensitivity and specificity of 100% and 96%, respectively, while LE was only 81% sensitive albeit 97% specific. They concluded that alpha defensin was of greater specificity. Deirmengian et al. compared alpha-defensin to LE as markers of PJI, as diagnosed by MSIS criteria. They found that alpha-defensin was 100% sensitive and specific at diagnosis, while LE was 69% sensitive and 100% specific. They also found that 17% of LE test strips could not be interpreted due to blood interference. The authors concluded that alpha defensin was a superior marker for infection. Incorrect Answers: Answer 2: The intraoperative frozen section has a sensitivity of 85% and specificity of 90-95%. Answer 3: Serum IL-6 has a sensitivity of 100% and a specificity of 95%. Answer 4: CRP has demonstrated a sensitivity of 88-96% and specificity of 70-77% for PJI. Answer 5: Multiple studies have compared synovial alpha-defensin to LE colorimetric strip testing and have shown alpha defensin to be more sensitive and specific for PJI.
2.8
(6)
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