Synovial-Based Tests Outperform Serum Markers to Rule Out Infection in Total Joint Arthroplasties
Total knee arthroplasty (TKA) provides successful results in most patients. Periprosthetic joint infection (PJI) accounts for up to 25% of failed TKAs needing revision. In the clinical workup for revision TKA and revision total hip arthroplasty (THA), the differentiation between septic and aseptic failure is important because both surgical and postoperative treatment strategies differ substantially. In clinical practice, consensus in diagnostic strategy for excluding or diagnosing PJI is still lacking.
A literature search by A. Goud et al in EMBASE, MEDLINE, PubMed, and Cochrane was conducted. Studies involving the diagnosis of PJI in patients with failed TKAs and total hip arthroplasties needing revision were identified. Only studies using the Musculoskeletal Infection Society criteria were included. Quality was assessed using MINORS criteria.
Meta-analysis was performed for each diagnostic test identified in the included studies. Pooled estimates of diagnostic accuracy measures were calculated using a bivariate model and plotted in summary receivereoperator characteristic curves. Positive and negative predictive values were calculated in a hypothetical sample of patients with a given disease prevalence.
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