Abstract
Introduction
In revision surgery, detection of periprosthetic joint infection is of prime importance. Valuable preoperative and intraoperative diagnostic tests and tools are necessary. The classical standard procedures are puncture and bacteriology examination, frozen section intraoperative and powerfield micro analysis.
Since autumn 2014 a new device for detection of periprosthetic joint infection is available, named Synovasure. It is a fast test for the detection of Alpha defensing, which plays a major role in the antimicrobial defence and only occurs in inflammatory processes.
„The alpha-defensin test is an immunoassay that measures the concentration of the alpha-defensin peptide in human synovialfluid. A-Defensin is an antimicrobial peptide that is secreted into the synovial fluid by human cells in response to pathogenic presence” (Deirmengian C et al., CORR 2014).
Summarized, the evidence of Alpha defensin indicates infection. It is produced by CD Diagnostics (Wynnewood, PA, USA) and merchandised by Zimmer (Warsaw, IL, USA).
We are using Synovasure in daily routine at our department since September 2014. The aim of this conducted study is to present our first clinical experience and to report our results of the first 54 cases.
Material and Methods
At our department Synovasure is standardly used in hip and knee revision surgery.
Additionally an intraoperative frozen section and a standard bacteriology were performed. The explanted endprosthesis were sent to examination by sonification in order to gain culture of the sonification fluid and were further examined by Multiplex PCR. A pathologist with more than 15 years of experience conducted the frozen section. The results of Synovasure were matched with all above examinations in order to describe specifity and sensitivity of it.
Results
A negative Synovasure Test during surgery and a negative PCR were observed in 3 patients, however, the bacterial culture was positive (after 14 days of breeding) as well as the Multiplex PCR. One patient had a negative frozen section and a negative culture but a positive PCR. Another patient with a high CRP level, all clinical signs of infection and a positive Synovasure Test, had 6 negative cultures. This patient suffered from a Metallosis as well, due to a broken PE inlay of the TKA, which supports the previously stated that Metallosis may interfere this new tool. Unfortunately in this patient neither a frozen section nor a PCR are available.
One patient, who had explanation due to infection, underwent reimplantation. During surgery the Synovasure Test and the frozen section were negative (Synovial Fluid), but postoperatively a positive culture and a positive histological report for infection were assessed.
Furthermore, a total of 5 tests showed an application error and the test did not show any control line.
Conclusion
In conclusion Synovasure helps to detect perprosthetic joint infection in an easy and fast manner. It is simple to integrate into daily routine, nevertheless all standardized examinations for infection need to be conducted.
