Mitterer Jennyfer A, Gardete Hartmann Susana, Simon Sebastian, Sebastian Sujeesh, Chlud Leonie, Hofstaetter Jochen G
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria.
2nd Department, Orthopaedic Hospital Speising, Vienna, Austria.
Arch Orthop Trauma Surg. 2025 Aug 28;145(1):428. doi: 10.1007/s00402-025-06045-x.
Two-stage revision arthroplasty is the standard treatment for chronic hip and knee periprosthetic joint infections (PJI). Accurate diagnosis of persistent infections at 2nd stage using established biomarkers and diagnostic criteria is of paramount importance. This study aimed to evaluate the diagnostic value of synovial calprotectin and alpha-defensin, and compare established diagnostic criteria from the International Consensus Meeting (ICM 2018) and the European Bone and Joint Infection Society (EBJIS 2021) to determine persistent PJI at the 2nd stage of a two-stage revision arthroplasty.
We retrospectively analyzed 97 patients who underwent 100 two-stage revisions (hip: 39, knee: 61). Synovial fluid samples were assessed for calprotectin and alpha-defensin levels. ICM 2018 and EBJIS 2021 were applied to all patients undergoing 2nd stage revision. Receiver operating characteristic (ROC) curves and Youden Index were utilized to determine optimal cut-off values, and correlations between biomarkers were evaluated. The microbiological spectrum was analyzed at 2nd stage and re-revision surgery.
Calprotectin levels showed a sensitivity of 66.7%, specificity of 32.9%, and accuracy of 38.0% in predicting septic failure. Alpha-defensin showed sensitivity of 28.6%, specificity of 87.8%, and accuracy of 79.2%. Significant correlations included: calprotectin with PMN% (r = 0.471, p = 0.05) and alpha-defensin with WBC (r = 0.830, p < 0.01) in the successful cohort. For septic re-revisions, calprotectin and alpha-defensin were highly correlated (r = 0.969, p < 0.01). ICM correctly diagnosed persistent PJI in 26.7%, while EBJIS diagnosed 24.2%. The microbial spectrum shifted from gram-positive to gram-negative bacteria between reimplantation and re-revision surgeries.
Synovial calprotectin and alpha-defensin demonstrated limited accuracy in ruling out persistent PJI at reimplantation. The low sensitivity of current diagnostic criteria, combined with the observed shift in microbial spectrum, underscores the challenges in diagnosing persistent PJI during 2nd stage of a two-stage revisions arthroplasty.
两阶段翻修关节成形术是慢性髋膝关节假体周围关节感染（PJI）的标准治疗方法。使用既定的生物标志物和诊断标准准确诊断第二阶段的持续性感染至关重要。本研究旨在评估滑膜钙卫蛋白和α-防御素的诊断价值，并比较国际共识会议（ICM 2018）和欧洲骨与关节感染学会（EBJIS 2021）的既定诊断标准，以确定两阶段翻修关节成形术第二阶段的持续性PJI。
我们回顾性分析了97例行100次两阶段翻修手术的患者（髋关节：39例，膝关节：61例）。评估滑液样本中的钙卫蛋白和α-防御素水平。将ICM 2018和EBJIS 2021应用于所有接受第二阶段翻修的患者。利用受试者操作特征（ROC）曲线和尤登指数确定最佳临界值，并评估生物标志物之间的相关性。在第二阶段和再次翻修手术时分析微生物谱。
钙卫蛋白水平在预测感染性失败方面的敏感性为66.7%，特异性为32.9%，准确性为38.0%。α-防御素的敏感性为28.6%，特异性为87.8%，准确性为79.2%。在成功队列中，显著相关性包括：钙卫蛋白与PMN%（r = 0.471，p = 0.05）以及α-防御素与白细胞（r = 0.830，p < 0.01）。对于感染性再次翻修，钙卫蛋白和α-防御素高度相关（r = 0.969，p < 0.01）。ICM正确诊断持续性PJI的比例为26.7%，而EBJIS诊断的比例为24.2%。在再次植入和再次翻修手术之间，微生物谱从革兰氏阳性菌转变为革兰氏阴性菌。
滑膜钙卫蛋白和α-防御素在排除再次植入时的持续性PJI方面准确性有限。当前诊断标准的低敏感性，加上观察到的微生物谱变化，凸显了在两阶段翻修关节成形术第二阶段诊断持续性PJI的挑战。
