Alpha Defensin: What is its Role in Detecting Periprosthetic Joint Infection

Periprosthetic Joint Infection (PJI) is on the rise and is one of the main causes of knee and hip revision, responsible for 25% of failed knee arthroplasties and 15% of failed hip arthroplasties. 1

As a result of the frequency, PJI is considered one of the leading challenges facing orthopedic surgeons today. Voting at the 2018 ICM Meeting showed that in the absence of any major criteria, not only was alpha defensin as a biomarker a valuable complement to existing diagnostic minor criteria for PJI but was also given significant individual test weight in the newly proposed scoring system for diagnosing PJI.*

* Synovasure AD was validated against 2013 criteria

 

Question as posed at ICM: What is the International Consensus Meeting on Periprosthetic Joint Infection?

The International Consensus Meeting (ICM) on Periprosthetic Joint Infection (PJI) addresses the wide variation globally for prevention, diagnosis and treatment of PJI. Currently, a single test that serves as the “gold standard” to aid in the diagnosis of PJI does not exist. As a result, a wide spectrum of tests to diagnose the condition are utilized.

 

Question as posed at ICM: What is the role of alpha defensin in the diagnosis of PJI?

The ICM recommended that the measurement of alpha defensin in synovial fluid is a valuable complement to existing diagnostic criteria for PJI but was also given significant individual test weight in the newly proposed scoring system for diagnosing PJI.3

 

Question as posed at ICM: Are point-of-care/rapid tests for diagnosing PJI validated and useful?

The recommendation by ICM is yes, there are several useful point-of-care tests which can be added to the diagnostic workup of PJIs. A number of studies support the usefulness and reliability of the leukocyte esterase (LE) test strip and the alpha defensin lateral flow test kit*. Diagnostic criteria for PJIs should be updated and consider inclusion of these tests.3

*Note: Synovasure® Alpha defensin lateral flow is not approved for sale in the United States. Synovasure Alpha Defensin Lateral Flow test is not cleared for Point of Care indication in the US.

 

The complete results of the 2nd ICM can be found on the International Consensus Meeting on Prosthetic Joint Infection’s website here

  1. Diermengian C, et al. Diagnosing Periprosthetic Joint Infection: Has the Era of the Biomarker Arrived? Clin. Orthop. Relat. Res. 2014 Nov;472(11):3254-62.
  2. Parvizi J, Gehrke T; International Consensus Group on Periprosthetic Joint Infection. Definition of periprosthetic joint infection. J Arthroplasty. 2014 Jul;29(7):1331. doi:0.1016/j.arth.2014.03.009
  3. Amanatullah D, et al. Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. Journal of Arthroplasty. Advance Online Publication. doi.org/10.1016/j.arth.2018.09.044
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