Banousi Angeliki, Vossos Alkiviadis, Mourikis Anastasios, Papadakis Stamatios, Fandridis Emmanouil
National and Kapodistrian University of Athens, Athens, Greece.
General Hospital KAT, Athens, Greece.
Eur J Orthop Surg Traumatol. 2025 May 26;35(1):216. doi: 10.1007/s00590-025-04321-5.
Diagnosing periprosthetic joint infections (PJI) are challenging and may be hampered by the presence of other causes of local inflammation. Recently, several synovial biomarkers have been introduced into the algorithm for the diagnosis of a PJI. Calprotectin is a protein that is present in the cytoplasm of neutrophils, is released upon neutrophil activation, and exhibits antimicrobial activity. The purpose of this study is to demonstrate calprotectin as a promising biomarker for the diagnosis of PJIs.
This retrospective single-center study (Dec 2020-Nov 2023) included 52 patients undergoing revision arthroplasty on the grounds of confirmed or suspected infection as per the criteria of the Infectious Diseases Society of America (IDSA) for PIJs. Synovial fluid calprotectin was measured intraoperatively using a quantitative lateral flow assay. Diagnostic accuracy was evaluated against tissue culture using ROC analysis, Cohen's kappa, sensitivity, and specificity.
Revision procedures included hip (44%), knee (25%), and shoulder (8%) arthroplasties. Calprotectin testing indicated high infection risk in 40.4% of patients, while periprosthetic tissue cultures were positive in 53.8%. Agreement between the tests was good (Cohen's kappa = 0.735). Calprotectin testing showed a sensitivity of 75%, specificity of 100%, positive predictive value of 100%, negative predictive value of 78%, and an area under the receiver operating characteristic curve of 0.875.
The study highlights the diagnostic value of synovial fluid calprotectin as a diagnostic biomarker with high sensitivity and specificity in the diagnosis of PJI.
诊断人工关节周围感染（PJI）具有挑战性，其他局部炎症原因可能会妨碍诊断。最近，几种滑膜生物标志物已被纳入PJI诊断算法中。钙卫蛋白是一种存在于中性粒细胞胞质中的蛋白质，在中性粒细胞激活时释放，并具有抗菌活性。本研究的目的是证明钙卫蛋白是一种有前景的PJI诊断生物标志物。
这项回顾性单中心研究（2020年12月至2023年11月）纳入了52例根据美国传染病学会（IDSA）的PJI标准因确诊或疑似感染而接受翻修关节成形术的患者。术中使用定量侧向流动分析法测量滑液钙卫蛋白。使用ROC分析、Cohen's kappa、敏感性和特异性，对照组织培养评估诊断准确性。
翻修手术包括髋关节置换术（44%）、膝关节置换术（25%）和肩关节置换术（8%）。钙卫蛋白检测表明40.4%的患者感染风险高，而假体周围组织培养阳性率为53.8%。两项检测之间的一致性良好（Cohen's kappa = 0.735）。钙卫蛋白检测的敏感性为75%，特异性为100%，阳性预测值为100%，阴性预测值为78%，受试者工作特征曲线下面积为0.875。
该研究强调了滑液钙卫蛋白作为一种诊断生物标志物在PJI诊断中具有高敏感性和特异性的诊断价值。
