Articles | Volume 10, issue 6
https://doi.org/10.5194/jbji-10-525-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-525-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
03 Dec 2025
Review |
| 03 Dec 2025
| 03 Dec 2025
Diagnostic accuracy of alpha-defensin ELISA and lateral flow assays for periprosthetic joint infection: a systematic review and meta-analysis
Benjamin R. Paul
Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona 85054, USA
Creighton University School of Medicine, Phoenix, Arizona 85012, USA
Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona 85054, USA
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
Alex Soriano
Department of Infectious Diseases, Hospital Clinic Barcelona, Barcelona, Spain
Andy Miller
Department of Infectious Diseases, Hospital for Special Surgery, New York, New York 10021, USA
Thorsten M. Seyler
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Laura Bessems, Jolien Onsea, Baixing Chen, Marjan Wouthuyzen-Bakker, Irene K. Sigmund, Tristan Ferry, Richard Kuehl, Martin Clauss, Alex Soriano, Ricardo Sousa, Annette Schuermans, and Willem-Jan Metsemakers
J. Bone Joint Infect., 10, 489–500, https://doi.org/10.5194/jbji-10-489-2025, https://doi.org/10.5194/jbji-10-489-2025, 2025
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Isolation of patients with musculoskeletal infections in orthopedic care is controversial. Evidence supports selective isolation for certain resistant pathogens but not for non-resistant pathogens, nor does it support the routine use of septic wards. Effective infection control depends on hospital-wide strategies and adherence to standard precautions, with specialized centres offering better care than dedicated isolation units.
Marta Sabater-Martos, Laura Morata, Josep Maria Segur, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 237–241, https://doi.org/10.5194/jbji-10-237-2025, https://doi.org/10.5194/jbji-10-237-2025, 2025
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This study's aim was to analyse the healing and failure rates of one-stage knee replacement in patients with positive and negative preoperative cultures and sinus presence. We concluded that culture-negative infections or the presence of a sinus tract showed similar results compared to patients that had undergone the same procedure with positive cultures or spared soft tissue.
Hendrika M. Schenk, Marine Sebillotte, Jose Lomas, Adrian Taylor, Eva Benavent, Oscar Murillo, Marta Fernandez-Sampedro, Kaisa Huotari, Craig Aboltins, Rihard Trebse, Alex Soriano, Marjan Wouthuyzen-Bakker, and on behalf of the ESCMID Study Group on Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 10, 217–224, https://doi.org/10.5194/jbji-10-217-2025, https://doi.org/10.5194/jbji-10-217-2025, 2025
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Patients with rheumatoid arthritis have a high treatment failure rate when faced with a late acute periprosthetic joint infection. Because of the rarity of the condition, we performed a multicenter case-control study. We identified predictors of treatment failure to ultimately improve the treatment outcome. Exchange of modular components seems important in this patient group, likely due to a higher rate of positive blood cultures compared to control patients.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
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This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Irene K. Sigmund, Tristan Ferry, Ricardo Sousa, Alex Soriano, Willem-Jan Metsemakers, Martin Clauss, Rihard Trebse, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 10, 101–138, https://doi.org/10.5194/jbji-10-101-2025, https://doi.org/10.5194/jbji-10-101-2025, 2025
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In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 41–49, https://doi.org/10.5194/jbji-10-41-2025, https://doi.org/10.5194/jbji-10-41-2025, 2025
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This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.
Laia Boadas-Gironès, Marta Sabater-Martos, Marc Ferrer-Banus, Àlex Soriano-Viladomiu, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 241–248, https://doi.org/10.5194/jbji-9-241-2024, https://doi.org/10.5194/jbji-9-241-2024, 2024
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When acute soft tissue defects are present after knee arthroplasty, the infection risk is high. A gastrocnemius flap is used for anterior defects, and it is not usually combined with debridement surgery unless infection is clear. We examined the benefit of combining coverage treatment with debridement surgery, DAIR, comparing the isolated traditional coverage treatment. The results suggested a higher healing rate in the combined treatment, so we recommended it.
Seung-Jae Yoon, Paul C. Jutte, Alex Soriano, Ricardo Sousa, Wierd P. Zijlstra, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 9, 231–239, https://doi.org/10.5194/jbji-9-231-2024, https://doi.org/10.5194/jbji-9-231-2024, 2024
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This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.
Eytan M. Debbi, Tyler Khilnani, Ioannis Gkiatas, Yu-Fen Chiu, Andy O. Miller, Michael W. Henry, and Alberto V. Carli
J. Bone Joint Infect., 9, 127–136, https://doi.org/10.5194/jbji-9-127-2024, https://doi.org/10.5194/jbji-9-127-2024, 2024
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Reported success rates of the different surgical options to treat periprosthetic infection vary in the literature. However, these rates rely on how authors define success. The goal of this study was to determine the most commonly used definitions of success based on a classification system published by the Musculoskeletal Infection Society. We found most studies did not use the strictest definitions of success, and success rates decreased when stricter definitions were used.
Marta Sabater-Martos, Marc Ferrer, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 17–26, https://doi.org/10.5194/jbji-9-17-2024, https://doi.org/10.5194/jbji-9-17-2024, 2024
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This is a meta-analysis of six studies describing the cutoff values of white blood cell count and polymorphonuclear percentage in synovial fluid for the diagnosis of acute postoperative peri-prosthetic joint infection (PJI).
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
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Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, Alba Ribera, Javier Ariza, María Dolores del Toro, Sophie Nguyen, Eric Senneville, Eric Bonnet, Monica Chan, Maria Bruna Pasticci, Sabine Petersdorf, Natividad Benito, Nuala O' Connell, Antonio Blanco García, Gábor Skaliczki, Pierre Tattevin, Zeliha Kocak Tufan, Nikolaos Pantazis, Panayiotis D. Megaloikonomos, Panayiotis Papagelopoulos, Alejandro Soriano, Antonios Papadopoulos, and the ESGIAI collaborators study group
J. Bone Joint Infect., 7, 279–288, https://doi.org/10.5194/jbji-7-279-2022, https://doi.org/10.5194/jbji-7-279-2022, 2022
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Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.
Jason S. Hoellwarth, Taylor J. Reif, Michael W. Henry, Andy O. Miller, Austin C. Kaidi, and S. Robert Rozbruch
J. Bone Joint Infect., 7, 155–162, https://doi.org/10.5194/jbji-7-155-2022, https://doi.org/10.5194/jbji-7-155-2022, 2022
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The stoma for transcutaneous osseointegration carries a permanent source of bacterial ingress and infection. The value and role of intraoperative cultures to detect latent bacterial contamination or infection with targeted postoperative antibiotics has not been previously investigated. We compared two cohorts, 8 patients with unexpected positive cultures and 22 patients with negative intraoperative cultures, and found positive cultures do not appear to portend future infectious events.
Ernesto Muñoz-Mahamud, Eduard Tornero, José A. Estrada, Jenaro A. Fernández-Valencia, Juan C. Martínez-Pastor, and Álex Soriano
J. Bone Joint Infect., 7, 109–115, https://doi.org/10.5194/jbji-7-109-2022, https://doi.org/10.5194/jbji-7-109-2022, 2022
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A patient with normal D-dimer value has a low risk of prosthetic joint infection, so serum D-dimer assessment should always be considered as a useful test to rule out chronic prosthetic joint infection (especially in those cases caused by low-virulence microorganisms in which conventional tests may lead to misdiagnosis). Conversely, the platelet count to mean platelet volume ratio may be of limited value for accurately diagnosing prosthetic joint infection.
Karel-Jan Dag François Lensen, Rosa Escudero-Sanchez, Javier Cobo, Rihard Trebše, Camelia Gubavu, Sara Tedeschi, Jose M. Lomas, Cedric Arvieux, Dolors Rodriguez-Pardo, Massimo Fantoni, Maria Jose Garcia Pais, Francisco Jover, Mauro José Costa Salles, Ignacio Sancho, Marta Fernandez Sampedro, Alex Soriano, Marjan Wouthuyzen-Bakker, and ESCMID Study Group of Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 6, 313–319, https://doi.org/10.5194/jbji-6-313-2021, https://doi.org/10.5194/jbji-6-313-2021, 2021
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Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.
Ernesto Muñoz-Mahamud, Jenaro Ángel Fernández-Valencia, Andreu Combalia, Laura Morata, and Álex Soriano
J. Bone Joint Infect., 6, 85–90, https://doi.org/10.5194/jbji-6-85-2021, https://doi.org/10.5194/jbji-6-85-2021, 2021
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A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.
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Short summary
A total of 51 studies were reviewed to compare the alpha-defensin enzyme-linked immunosorbent assay (ELISA) and the lateral flow test for diagnosing joint replacement infections. Both tests are highly specific and accurately confirm infection, but ELISA showed greater sensitivity (87.8 % vs. 81.8 %), making it better for detection. These findings support the continued use of ELISA as the preferred diagnostic method.
A total of 51 studies were reviewed to compare the alpha-defensin enzyme-linked immunosorbent...
