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Alpha defensin lateral flow test yielded high specificity, limited sensitivity for PJI
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Although use of the alpha defensin lateral flow test was rapid and highly specific for diagnosing periprosthetic joint infection, results published in The Journal of Bone and Joint Surgery showed it had limited sensitivity. Researchers recommend it should be used as a confirmatory test and not for screening.
Andrej Trampuz, MD, and colleagues performed the alpha defensin lateral flow test in synovial fluid and performed standard diagnostic tests for 212 patients who underwent aspiration of a prosthetic hip or knee joint before revision arthroplasty. Periprosthetic joint infection (PJI) or aseptic failure was classified according to the definition criteria of the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA) and the proposed criteria of the European Bone and Joint Infection Society (EBJIS).
Results showed MSIS criteria identified PJI in 21% of patients, IDSA criteria identified PJI in 26% of patients and proposed EBJIS criteria identified PJI in 37% of patients. Researchers noted the alpha defensin lateral flow test had a sensitivity of 84%, 67% and 54% with the MSIS, IDSA and proposed EBJIS criteria, respectively. Using all classification criteria, the alpha defensin lateral flow test had high specificity. Researchers also found the alpha defensin lateral flow test was the most specific preoperative test for PJI, especially during the early postoperative period. Results showed a significantly higher sensitivity of the leukocyte count when using the proposed EBJIS definition criteria vs. the alpha defensin lateral flow test, particularly in patients with chronic PJI.
“The alpha defensin lateral flow test in synovial fluid was rapid and highly specific for diagnosing PJI (greater than 95%). However, its sensitivity was limited, especially when the more sensitive European Bone and Joint Infection Society definition criteria were used (54%),” Trampuz told Healio.com/Orthopedics. “Therefore, the alpha defensin should not be used for screening, but rather as a confirmatory test for periprosthetic joint infections.” – by Casey Tingle
Disclosures: Trampuz reports he received grants from Zimmer Biomet. Please see the full study for a list of all other authors’ relevant financial disclosures.
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