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Table 3 Diagnostic value of different diagnostic method for the diagnosis of PJI

From: Synovial fluid α-defensin in the diagnosis of periprosthetic joint infection: the lateral flow test is an effective intraoperative detection method

Diagnostic method Study Sensitivity (95% CI) Specificity (95% CI) PLR (95% CI) NLR (95% CI) DOR (95% CI) AUC (95% CI)
Synovial fluid biomarkers and aspiration culture
 Aspiration culture Qu et al., 2013 [8] 0.72 (0.65–0.78) 0.95 (0.93–0.97) 15.3 (10.6–22.1) 0.29 (0.23–0.38) 52.00 (31.00–86.00) 0.94 (0.92–0.96)
 White cell count Qu et al., 2014 [52] 0.88 (0.81–0.93) 0.93 (0.88–0.96) 13.30 (7.70–22.80) 0.13 (0.08–0.21) 103.00 (54.00–197.00) 0.96 (0.94–0.98)
 Polymorphonuclear Qu et al., 2014 [52] 0.90 (0.84–0.93) 0.88 (0.83–0.92) 7.60 (4.90–11.70) 0.12 (0.07–0.19) 64.00 (27.00–149.00) 0.95 (0.93–0.96)
 C-reactive protein Wang et al., 2016 [53] 0.92 (0.86–0.96) 0.90 (0.87–0.93) 9.00 (6.15–13.16) 0.10 (0.06–0.18) 101.40 (48.07–213.93) 0.97 NA
 Leukocyte esterase Wyatt et al., 2016 [34] 0.81 (0.49–0.95) 0.97 (0.82–0.99) 23.90 (3.80–152.10) 0.19 (0.06–0.66) NA 0.97 (0.95–0.98)
 Interleukin-6 Xie et al., 2017 [54] 0.91 (0.82–0.96) 0.90 (0.84–0.95) 9.50 (5.40–17.20) 0.09 (0.04–0.21) 101.00 (28.00–358.00) 0.96 (0.94–0.98)
 Alpha-defensin (Immunoassay) Current study 0.96 (0.90–0.98) 0.97 (0.95–0.99) 35.0 (18.5–66.2) 0.04 (0.02–0.11) 811 (220–2290) 0.99 (0.98–1.00)
 Alpha-defensin (lateral flow test) Current study 0.86 (0.81–0.91) 0.96 (0.93–0.98) 21.2 (11.7–38.5) 0.14 (0.10–0.21) 148 (64–343) 0.95 (0.93–0.97)
Serum biomarkers
 White cell count Berbari et al., 2010 [55] 0.45 (0.41–0.49) 0.87 (0.85–0.89) NA NA 4.40 (2.90–6.60) NA
 Erythrocyte sedimentation rate Berbari et al., 2010 [55] 0.75 (0.72–0.77) 0.70 (0.68–0.72) NA NA 7.20 (4.70–10.90) NA
 C-reactive protein Yuan et al., 2014 [56] 0.82 (0.80–0.84) 0.77 (0.76–0.78) 3.66 (2.92–4.59) 0.26 (0.20–0.33) 17.01 (11.38–25.44) 0.88 (0.86–0.89)
 Procalcitonin Xie et al., 2017 [33] 0.53 (0.24–0.80) 0.92 (0.45–0.99) 6.80 (1.00–48.10) 0.51 (0.31–0.84) 13.00 (3.00–70.00) 0.76 (0.72–0.80)
 Interleukin-6 Xie et al., 2017 [54] 0.72 (0.63–0.80) 0.89 (0.77–0.95) 6.40 (2.90–14.10) 0.31 (0.22–0.44) 20.00 (7.00–58.00) 0.83 (0.79–0.86)
Nuclear medicine
 Bone scintigraphy Ouyang et al., 2014 [57] 0.83 (0.72–0.90) 0.73 (0.65–0.80) 3.10 (2.40–4.10) 0.23 (0.14–0.38) 14.00 (7.00–26.00) 0.85 (0.81–0.87)
 Anti-granulocyte scintigraphy Xing et al., 2013 [58] 0.83 (0.79–0.87) 0.79 (0.75–0.83) 3.56 (2.42–5.23) 0.26 (0.19–0.37) 18.76 (10.45–33.68) 0.88 NA
 Leukocyte scintigraphy Verbern et al., 2016 [59] 0.88 NA 0.92 NA NA NA NA NA
 FDG-PET Verbern et al., 2016 [59] 0.86 NA 0.93 NA NA NA NA NA
Other tests with biopsy
 Frozen section histopathology Tsaras et al., 2012 [51] NA NA 12.00 (8.40–17.20) 0.23 (0.15–0.35) 54.7 (31.2–95.7) NA
 PCR assays Qu et al., 2014 [52] 0.86 (0.77–0.92) 0.91 (0.81–0.96) 9.10 (4.60–18.20) 0.16 (0.10–0.25) 59.00 (29.00–118.00) 0.94 (0.91–0.95)
 Sonication fluid cultures Zhai et al., 2014 [60] 0.80 (0.74–0.84) 0.95 (0.90–0.98) 17.20 (7.60–38.70) 0.21 (0.17–0.27) 81.00 (35.00–186.00) 0.89 (0.86–0.91)
 Gram staining Ouyang et al., 2015 [61] 0.19 (0.12–0.27) 1.00 (0.99–1.00) 41.60 (15.50–111.20) 0.82 (0.75–0.89) 51.00 (18.00–140.00) 0.89 (0.86–0.91)
  1. If one diagnostic method was reported by more than one meta-analysis, the most detailed and/or recent one was included in this table. PLR positive likelihood ratio, NLR negative likelihood ratio, DOR diagnostic odds ratio, AUC area under the curve, Immunoassay laboratory-based immunoassay, FDG-PET 18F-fluoro-2-deoxyglucose positron emission tomography, PCR polymerase chain reaction