Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.565
Peer-review started: April 24, 2021
First decision: June 7, 2021
Revised: June 14, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: August 18, 2021
Processing time: 108 Days and 22.4 Hours
The quantitative alpha-defensin enzyme-linked immunosorbent assay (ELISA) demands a prior synovial fluid centrifugation, whereas this processing is not routinely required prior to the alpha-defensin lateral flow test.
To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection (PJI) diagnosis.
Fifty-three cases were included in this study: 22 classified as PJI and 31 classified as aseptic cases, according to Musculoskeletal Infection Society 2013 criteria. Synovial fluid samples were submitted to centrifugation, and the supernatant was evaluated by ELISA and lateral flow tests. The sensitivity (SE), specificity (SP) and accuracy of each method were calculated as well as the agreement between those two methods.
In all of the 31 samples from aseptic patients, alpha-defensin ELISA and lateral flow tests showed negative results for infection. Regarding the 22 infected patients, the lateral flow test was positive in 19 cases (86.4%) and the ELISA was positive in 21 (95.5%). Sensibility, SP and accuracy were, respectively, 86.4% (95%CI: 65.1%-97.1%), 100% (95%CI: 88.8%-100%) and 93.2% (95%CI: 82.8%-98.3%) for the lateral flow test and 95.5% (95%CI: 77.2%-99.9%), 100% (95%CI: 88.8%-100%) and 98.1% (95%CI: 89.9%-100%) for ELISA. An agreement of 96.2% between those methods were observed. No statistical difference was found between them (P = 0.48).
Alpha-defensin lateral flow test showed high SE, SP and accuracy after a prior synovial fluid centrifugation, achieving comparable results to ELISA. Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition, a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.
Core Tip: This was a prospective study seeking to evaluate whether the synovial fluid centrifugation prior to the alpha-defensin lateral flow test leads to comparable results in relation to the alpha-defensin enzyme-linked immunosorbent assay (ELISA) during periprosthetic joint infection of the knee. Prior centrifugation of the synovial fluid showed to achieve high sensitivity, specificity and accuracy for the lateral flow test during periprosthetic joint infection diagnosis, leading to similar results in comparison to alpha-defensin ELISA.