Charlotte Bielefeld1,2, Harald Engler3, Marcus JÄger4,2, Alexander Wegner1,2, Dennis Wassenaar1,2, Andre Busch1,2. 1. Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital, Mülheim an der Ruhr, Germany. 2. Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Mülheim an der Ruhr, Germany. 3. Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. 4. Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien Hospital, Mülheim an der Ruhr, Germany; M.Jaeger@contilia.de.
Abstract
BACKGROUND/AIM: Owing to the lack of a diagnostic gold standard, ruling out persistent periprosthetic joint infection (PJI) before second-stage surgery in the setting of two-stage revision arthroplasty constitutes a major challenge. We evaluated if the alpha-defensin-1 (AD-1) test could predict successful infection eradication before reimplantation of a new prosthesis. PATIENTS AND METHODS: Our prospective study included 20 patients who underwent two-stage revision arthroplasty for treatment of PJI. A standard quantitative enzyme AD-1 immunoassay of synovial fluid, the synovial leukocyte esterase test and routine laboratory blood testing were performed prior to explantation and reimplantation. Treatment failure was defined according to the Delphi-based consensus criteria after a minimum follow-up of 1 year. RESULTS: A 15% of our patients met the Delphi Criteria within 1 year. None of the markers investigated were significantly different in patients with and without reinfection. CONCLUSION: Further research is necessary to identify biomarkers more suitable for indicating persistent infection before reimplantation. Copyright
BACKGROUND/AIM: Owing to the lack of a diagnostic gold standard, ruling out persistent periprosthetic joint infection (PJI) before second-stage surgery in the setting of two-stage revision arthroplasty constitutes a major challenge. We evaluated if the alpha-defensin-1 (AD-1) test could predict successful infection eradication before reimplantation of a new prosthesis. PATIENTS AND METHODS: Our prospective study included 20 patients who underwent two-stage revision arthroplasty for treatment of PJI. A standard quantitative enzyme AD-1 immunoassay of synovial fluid, the synovial leukocyte esterase test and routine laboratory blood testing were performed prior to explantation and reimplantation. Treatment failure was defined according to the Delphi-based consensus criteria after a minimum follow-up of 1 year. RESULTS: A 15% of our patients met the Delphi Criteria within 1 year. None of the markers investigated were significantly different in patients with and without reinfection. CONCLUSION: Further research is necessary to identify biomarkers more suitable for indicating persistent infection before reimplantation. Copyright
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