Table 10 Diagnostic methods used for PJI detection ranked by the sensitivity (preoperative examination, intraoperative methods, and test before reimplantation)
From: Meta-analysis in periprosthetic joint infection: a global bibliometric analysis
Reference | Year | No. of studies | Sen (95% CI) | Spe (95% CI) | |
|---|---|---|---|---|---|
Preoperative examination | |||||
Synovial fluid alpha-defensin immunoassay | [14] | 2016 | 6 | 1.00 (0.82–1.00) | 0.96 (0.89–0.99) |
Synovial fluid ELISA | [15] | 2018 | 4 | 0.98 (0.94–1.00) | 0.97 (0.95–0.99) |
Synovial fluid alpha-defensin immunoassay | [16] | 2019 | 7 | 0.98 (0.94–0.99) | 0.96 (0.94–0.98) |
Synovial fluid a-defensin | [17] | 2017 | 7 | 0.97 (0.93–0.99) | 0.96 (0.94–0.98) |
Serum IL-6 | [18] | 2010 | 3 | 0.97 (0.93–0.99) | 0.91 (0.87–0.94) |
Synovial fluid ELISA | [19] | 2018 | 4 | 0.97 (0.91–0.99) | 0.97 (0.94–0.98) |
Synovial fluid alpha-defensin immunoassay | [20] | 2018 | 4 | 0.96 (0.90–0.98) | 0.96 (0.93–0.97) |
Synovial fluid alpha-defensin | [21] | 2017 | 11 | 0.96 (0.87–0.99) | 0.95 (0.91–0.97) |
Synovial fluid alpha-defensin | [22] | 2016 | 6 | 0.96 (0.85–0.99) | 0.95 (0.89–0.98) |
Synovial fluid alpha-defensin immunoassay | [23] | 2018 | 7 | 0.95(0.87–0.98) | 0.97 (0.94–0.98) |
Synovial fluid ELISA | [24] | 2018 | 4 | 0.95 (0.91–0.98) | 0.97 (0.95–0.98) |
Bone scintigraphy | [25] | 2017 | 6 | 0.93 (0.85–0.98) | 0.56 (0.47–0.64) |
Synovial fluid CRP | [26] | 2016 | 6 | 0.92 (0.86–0.96) | 0.90 (0.87–0.93) |
Synovial fluid ELISA | [27] | 2019 | 4 | 0.92 (0.86–0.96) | 0.99 (0.98–1.00) |
Synovial fluid LE | [28] | 2015 | 4 | 0.92(0.86–0.96) | 0.95 (0.93–0.97) |
Synovial fluid PMN% | [29] | 2018 | 10 | 0.91 (0.87–0.93) | 0.86 (0.81–0.90) |
Synovial fluid IL-6 | [30] | 2017 | 8 | 0.91 (0.82–0.96) | 0.90 (0.84–0.95) |
Synovial fluid WCC/PMN% | [31] | 2014 | 9 | 0.91 (0.82–0.95) | 0.89 (0.81–0.94) |
Synovial fluid WBC | [29] | 2018 | 10 | 0.90 (0.87–0.92) | 0.90 (0.81–0.95) |
Synovial fluid PMN% | [31] | 2014 | 14 | 0.90 (0.84– 0.93) | 0.88 (0.83–0.92) |
AGS | [25] | 2017 | 5 | 0.90 (0.78–0.96) | 0.95 (0.88–0.98) |
Synovial fluid LE | [32] | 2018 | 8 | 0.90 (0.76–0.96) | 0.97 (0.95–0.98) |
Synovial fluid leukocyte count | [17] | 2017 | 12 | 0.89 (0.86–0.91) | 0.86 (0.80–0.90) |
Synovial fluid PMN% | [17] | 2017 | 10 | 0.89 (0.82–0.93) | 0.86 (0.77–0.92) |
Serum CRP | [18] | 2010 | 23 | 0.88 (0.86–0.90) | 0.74 (0.71–0.76) |
Synovial fluid WCC | [31] | 2014 | 15 | 0.88 (0.81–0.93) | 0.93 (0.88–0.96) |
Leukocyte scintigraphy | [25] | 2017 | 6 | 0.88 (0.81–0.93) | 0.77 (0.69–0.85) |
Leukocyte scintigraphy | [33] | 2016 | 6 | 0.88 (0.81– 0.94) | 0.92 (0.88–0.96) |
18F-FDG PET or PET/CT | [34] | 2017 | 16 | 0.87(0.83–0.90) | 0.87 (0.85–0.89) |
Serum CRP | [35] | 2017 | 11 | 0.87 (0.84–0.90) | 0.79 (0.77–0.80) |
Bone and leukocyte scintigraphy | [25] | 2017 | 4 | 0.87 (0.71–0.96) | 0.82 (0.72–0.90) |
Synovial fluid IL-8 | [17] | 2017 | 3 | 0.87 (0.67–0.96) | 0.94 (0.88–0.97) |
Serum ESR | [35] | 2017 | 12 | 0.86 (0.83–0.89) | 0.72 (0.70– 0.74) |
FDG PET or PET/CT | [36] | 2013 | 14 | 0.86 (0.82–0.90) | 0.86(0.83–0.89) |
Synovial fluid CRP | [19] | 2018 | 9 | 0.86 (0.81–0.91) | 0.90 (0.86–0.93) |
FDG PET | [33] | 2016 | 12 | 0.86 (0.80–0.90) | 0.93 (0.90–0.95) |
Synovial fluid lateral flow test | [27] | 2019 | 12 | 0.85 (0.80–0.89) | 0.96 (0.94–0.97) |
Synovial fluid CRP | [17] | 2017 | 10 | 0.85 (0.78–0.90) | 0.88 (0.78–0.94) |
Synovial fluid lateral flow test | [24] | 2018 | 6 | 0.85 (0.74–0.92) | 0.90 (0.91–0.98) |
Synovial fluid/serum CRP | [28] | 2015 | 15 | 0.845 (0.82–0.87) | 0.795 (0.78–0.81) |
Synovial fluid PCR | [37] | 2013 | 6 | 0.84 (0.75–0.93) | 0.89 (0.81–0.97) |
Synovial fluid lateral flow test | [16] | 2019 | 6 | 0.84 (0.74–0.91) | 0.94 (0.89–0.97) |
AGS | [33] | 2016 | 5 | 0.84 (0.70–0.93) | 0.75 (0.66–0.82) |
AGS with monoclonal antibodies | [38] | 2007 | 13 | 0.83(0.75–0.89) | 0.80 (0.75–0.84) |
Anti-granulocyte scintigraphy with 99 m Tc-labeled monoclonal antibodies | [39] | 2013 | 19 | 0.83 (0.79–0.87) | 0.79 (0.75–0.83) |
Synovial fluid/serum IL-6 | [40] | 2018 | 18 | 0.83 (0.74–0.89) | 0.91 (0.84–0.95) |
Three-phase bone scintigraphy | [41] | 2014 | 20 | 0.83 (0.72–0.90) | 0.73 (0.65–0.80) |
Synovial fluid/serum IL-6 | [28] | 2015 | 11 | 0.824 (0.78–0.87) | 0.85 (0.82–0.88) |
FDG-PET | [42] | 2008 | 11 | 0.82(0.68–0.91) | 0.87 (0.80–0.91) |
Serum CRP | [43] | 2014 | 25 | 0.82 (0.80–0.84) | 0.77 (0.76–0.78) |
Synovial fluid IL-6 | [17] | 2017 | 5 | 0.81 (0.70–0.89) | 0.94 (0.88–0.97) |
Synovial fluid LE | [14] | 2016 | 5 | 0.81 (0.49–0.95) | 0.97(0.82–0.99) |
Bone scintigraphy | [33] | 2016 | 8 | 0.80 (0.72–0.86) | 0.69 (0.64–0.73) |
Leukocyte and bone marrow scintigraphy | [25] | 2017 | 7 | 0.80 (0.66–0.91) | 0.93 (0.86–0.97) |
Synovial fluid Synovasure | [19] | 2018 | 6 | 0.80 (0.65–0.89) | 0.89 (0.76–0.96) |
Synovial fluid LE | [27] | 2019 | 12 | 0.79 (0.75–0.82) | 0.96 (0.95–0.97) |
Synovial fluid LE | [19] | 2018 | 12 | 0.79 (0.67–0.87) | 0.92 (0.87–0.92) |
Synovial fluid lateral flow test | [23] | 2018 | 3 | 0.77 (0.64–0.87) | 0.91 (0.83–0.96) |
Synovial fluid LE | [17] | 2017 | 5 | 0.77 (0.63–0.87) | 0.95 (0.86–0.98) |
Synovial fluid IL-6 | [19] | 2018 | 11 | 0.76 (0.65–0.84) | 0.91 (0.88–0.94) |
Serum ESR | [18] | 2010 | 25 | 0.75 (0.72–0.77) | 0.70 (0.68–0.72) |
Synovial fluid culture | [44] | 2013 | 34 | 0.72 (0.65–0.78) | 0.95 (0.93–0.97) |
Serum IL-6 | [30] | 2017 | 11 | 0.72 (0.63–0.80) | 0.89 (0.77–0.95) |
Synovial fluid lateral flow test | [20] | 2018 | 3 | 0.71 (0.55–0.83) | 0.90 (0.81–0.95) |
FDG-PET | [25] | 2017 | 5 | 0.70 (0.56–0.81) | 0.84 (0.76–0.90) |
Leukocyte and bone marrow scintigraphy | [33] | 2016 | 3 | 0.69 (0.58–0.79) | 0.96 (0.93–0.98) |
Synovial fluid culture | [17] | 2017 | 5 | 0.62 (0.50–0.74) | 0.94 (0.91–0.96) |
Serum PCT | [40] | 2018 | 6 | 0.58 (0.31–0.81) | 0.95 (0.63–1.00) |
Serum PCT | [22] | 2016 | 6 | 0.53 (0.24–0.80) | 0.92 (0.45–0.99) |
Serum WBC | [18] | 2010 | 15 | 0.45 (0.41–0.49) | 0.87 (0.85–0.89) |
Synovial fluid PCT | [28] | 2015 | 3 | 0.35(0.28–0.43) | 0.994 (0.97–1.00) |
Synovial fluid GS | [45] | 2015 | 4 | 0.30 (0.17–0.48) | 1.00 (0.88–1.00) |
Intraoperative examination | |||||
Tissue PCR | [37] | 2013 | 5 | 0.95 (0.91–0.99) | 0.81 (0.66–0.90) |
Sonicate fluid BCB | [46] | 2018 | 4 | 0.85 (0.77–0.91) | 0.86 (0.81–0.91) |
Sonicate fluid PCR | [37] | 2013 | 4 | 0.81 (0.71–0.91) | 0.96 (0.92–1.00) |
Sonicate fluid | [47] | 2014 | 12 | 0.80 (0.74–0.84) | 0.95 (0.90–0.98) |
Sonicate fluid | [48] | 2017 | 16 | 0.79 (0.76–0.81) | 0.95 (0.94–0.96) |
Synovial fluid WCC/PMN% | [31] | 2014 | 4 | 0.77 (0.51–0.91) | 0.97 (0.93–0.99) |
Sonicate fluid PCR | [49] | 2018 | 9 | 0.75 (0.71–0.79) | 0.96 (0.94–0.97) |
Tissue-frozen section [five leukocytes per high power field (400×)] | [50] | 2013 | 10 | 0.73 (0.65–0.80) | 0.90 (0.88–0.93) |
Tissue BCB | [51] | 2019 | 4 | 0.70 (0.66–0.75) | 0.97 (0.95–0.98) |
Tissue-frozen section [ten leukocytes per high power field (400×)] | [50] | 2013 | 5 | 0.64 (0.54–0.74) | 0.95 (0.93–0.97) |
Tissue GS | [45] | 2015 | 5 | 0.16 (0.08–0.29) | 0.99 (0.98–1.00) |
Tissue swab GS | [45] | 2015 | 3 | 0.14 (0.07–0.24) | 1.00 (0.97–1.00) |
Before reimplantation | |||||
Tissue culture | [52] | 2018 | 2 | 0.82 (0.72–0.90) | 0.91 (0.89–0.95) |
Synovial fluid PMN% | [52] | 2018 | 2 | 0.77 (0.46–0.95) | 0.74 (0.67–0.81) |
Synovial fluid PMN% | [53] | 2018 | 4 | 0.70 (0.58–0.81) | 0.71 (0.66–0.77) |
Synovial fluid culture | [52] | 2018 | 2 | 0.64 (0.52–0.74) | 0.96 (0.93–0.98) |
Serum ESR | [53] | 2018 | 5 | 0.57 (0.45–0.68) | 0.50 (0.45–0.56) |
Serum ESR | [52] | 2018 | 3 | 0.56 (0.40–0.72) | 0.60 (0.53–0.66) |
Serum CRP | [52] | 2018 | 3 | 0.53 (0.39–0.67) | 0.72 (0.66–0.78) |
Spacer sonicate fluid culture | [53] | 2018 | 4 | 0.53 (0.38–0.68) | 0.84 (0.76–0.90) |
Synovial fluid WBC | [53] | 2018 | 5 | 0.52 (0.41–0.63) | 0.66 (0.61–0.71) |
Serum CRP | [53] | 2018 | 8 | 0.45 (0.36–0.55) | 0.73 (0.69–0.77) |
Synovial fluid WBC | [52] | 2018 | 2 | 0.37 (0.19–0.58) | 0.49 (0.41–0.57) |
Tissue culture | [53] | 2018 | 9 | 0.30 (0.23–0.38) | 0.90 (0.87–0.92) |
Frozen section | [53] | 2018 | 4 | 0.29 (0.17–0.44) | 0.93 (0.89–0.96) |
Synovial fluid culture | [53] | 2018 | 5 | 0.18 (0.11–0.28) | 0.97 (0.94–0.99) |