Serum and Synovial Fluid Interleukin-6 for the Diagnosis of Periprosthetic Joint Infection.

A gold standard for diagnosis of periprosthetic joint infection (PJI) has not yet been established. The objective of this study was to evaluate the diagnostic value of serum and synovial fluid interleukin (IL)-6 levels for PJI. The MEDLINE and EMBASE databases were searched for studies describing PJI diagnosis using serum and synovial fluid IL-6 and published between January 1990 and October 2016. Seventeen studies were included in the analysis. The pooled sensitivities of serum and synovial fluid IL-6 were 0.72 (95% confidence interval [CI]: 0.63-0.80) and 0.91 (95% CI: 0.82-0.96), respectively. The pooled specificities of serum and synovial fluid IL-6 were 0.89 (95% CI: 0.77-0.95) and 0.90 (95% CI: 0.84-0.95), respectively. The pooled diagnostic odds ratios (DORs) of serum and synovial fluid IL-6 were 20 (95% CI: 7-58) and 101 (95% CI: 28-358), respectively, and the pooled areas under the curve (AUCs) were 0.83 (95% CI: 0.79-0.86) and 0.96 (95% CI: 0.94-0.98), respectively. Synovial fluid IL-6 had high diagnostic value for PJI. Although serum IL-6 test was less sensitive than synovial fluid IL-6 test, it may be regularly prescribed for patients with prosthetic failure owing to its high specificity.