Excellent Diagnostic Characteristics for Ultrafast Gene Profiling of in Detection of Prosthetic Joint Infections.

The timely and exact diagnosis of prosthetic joint infection (PJI) is crucial for surgical decision-making. Intraoperatively, delivery of the result within an hour is required. Alpha-defensin lateral immunoassay of joint fluid (JF) is precise for the intraoperative exclusion of PJI; however, for patients with a limited amount of JF and/or in cases where the JF is bloody, this test is unhelpful. Important information is hidden in periprosthetic tissues that may much better reflect the current status of implant pathology. We therefore investigated the utility of the gene expression patterns of 12 candidate genes (, -, -, -, and , , , , , , , and ) previously associated with infection for detection of PJI in periprosthetic tissues of patients with total joint arthroplasty (TJA) ( = 76) reoperated for PJI ( = 38) or aseptic failure ( = 38), using the ultrafast quantitative reverse transcription-PCR (RT-PCR) Xxpress system (BJS Biotechnologies Ltd.). Advanced data-mining algorithms were applied for data analysis. For PJI, we detected elevated mRNA expression levels of ( < 0.0001), ( < 0.0001), ( < 0.0001), ( = 0.02), and ( = 0.01) in comparison to those in tissues from aseptic cases. A feature selection algorithm revealed that the pattern was the most appropriate for detection/exclusion of PJI, achieving 94.5% sensitivity and 95.7% specificity, with likelihood ratios (LRs) for positive and negative results of 16.3 and 0.06, respectively. Taken together, the results show that gene expression detection by use of ultrafast qRT-PCR linked to an electronic calculator allows detection of patients with a high probability of PJI within 45 min after sampling. Further testing on a larger cohort of patients is needed.