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

Tim Cheok, Thomas Smith, Shihab Siddiquee, Matthew P. Jennings, Narlaka Jayasekera, Ruurd L. Jaarsma

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)311-320
Number of pages10
JournalThe bone & joint journal
Volume104-B
Issue number3
DOIs
Publication statusPublished - 1 Mar 2022

Keywords

  • Arthroplasty
  • biomarkers
  • Calprotectin
  • CRP
  • Interleukin-6
  • Musculoskeletal Infection
  • Periprosthetic joint infection (PJI)
  • Polymerase chain reaction
  • Prosthetic joint infection
  • regression analysis
  • serum
  • Synovial fluid

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this