Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. (1st March 2022)

• Record Type: Journal Article
• Authors: Cheok, Tim; Smith, Thomas; Siddiquee, Shihab; Jennings, Matthew P.; Jayasekera, Narlaka; Jaarsma, Ruurd L.
• Is Part Of: Bone & joint journal. Volume 104B:Number 3(2022)
• Page Start: 311
• Page End: 320
• Publication Date: 2022-03-01
• Subjects: Prosthetic joint infection -- Arthroplasty -- Polymerase chain reaction -- Interleukin-6 -- Calprotectin -- interleukin 6 -- Synovial fluid -- Periprosthetic joint infection (PJI) -- biomarkers -- Musculoskeletal Infection -- arthroplasty -- serum -- CRP -- regression analysis; Bones -- Surgery -- Periodicals; Joints -- Surgery -- Periodicals; Orthopedic surgery -- Periodicals; 617.47005
• DOI: 10.1302/0301-620X.104B3.BJJ-2021-1320.R1
• Languages: English
• ISSNs: 2049-4394

Abstract

Abstract : Aims: The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI. Methods: We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified. Results: Overall, 31 studies were identified: 20 described PCR, six described IL6, and five calprotectin. The sensitivity and specificity were 0.78 (95% confidence interval (CI) 0.67 to 0.86) and 0.97 (95% CI 0.94 to 0.99), respectively, for synovial PCR;, 0.86 (95% CI 0.74 to 0.92), and 0.94 (95% CI 0.90 to 0.96), respectively, for synovial IL6; and 0.94 (95% CI 0.82 to 0.98) and 0.93 (95% CI 0.85 to 0.97), respectively, for synovial calprotectin. Likelihood ratio scattergram analyses recommended clinical utility of synovial fluid PCR and IL6 as a confirmatory test only. Synovial calprotectin had utility in the exclusion and confirmation of PJI. Conclusion: Synovial fluid PCR and IL6 had low sensitivity and high specificity in the diagnosis of PJI, and is recommended to be used as confirmatory test. In contrast, synovial fluid calprotectin had both high sensitivity and specificity with utility in both the exclusion and confirmation of PJI. We recommend use of synovial fluid calprotectin studies in the preoperative workup of PJI. Cite this article: Bone Joint J 2022;104-B(3):311–320.