Despite several synovial fluid biomarkers for the diagnosis of periprosthetic joint infection (PJI) having been investigated, point-of-care (POC) tests using these biomarkers are not widely ...available. Synovial calprotectin has recently been reported to effectively exclude the diagnosis of PJI. Thus, the objective of this study was to test the value of a calprotectin POC test for PJI diagnosis in patients undergoing total knee arthroplasty (TKA) using the 2013 Musculoskeletal Infection Society (MSIS) PJI diagnosis criteria as the gold standard.
Synovial fluid samples were prospectively collected from 123 patients who underwent revision TKA at 2 institutions within the same health-care system from October 2018 to January 2020. The study was conducted under institutional review board approval. Data collection comprised demographic, clinical, and laboratory data in compliance with the MSIS criteria. Synovial fluid samples were analyzed by calprotectin POC tests in accordance with the manufacturer's instructions. Revisions were categorized as septic or aseptic using MSIS criteria by 2 independent reviewers blinded to the calprotectin results. Calprotectin test performance characteristics with sensitivities, specificities, positive predictive values, negative predictive values, and areas under the receiver operating characteristic curve (AUC) were calculated for 2 different PJI diagnosis scenarios: (1) a threshold of ≥50 mg/L, and (2) a threshold of ≥14 mg/L.
According to the MSIS criteria, 53 revision TKAs were septic and 70 revision TKAs were aseptic. In the ≥50-mg/mL threshold scenario, the calprotectin POC performance showed a sensitivity of 98.1%, a specificity of 95.7%, a positive predictive value of 94.5%, a negative predictive value of 98.5%, and an AUC of 0.969. In the ≥14-mg/mL threshold scenario, the sensitivity was 98.1%, the specificity was 87.1%, the positive predictive value was 85.2%, the negative predictive value was 98.4%, and the AUC was 0.926.
The calprotectin POC test has excellent PJI diagnostic characteristics, including high sensitivity and specificity in patients undergoing revision TKA. This test could be effectively implemented as a rule-out test. However, further investigations with larger cohorts are necessary to validate these results.
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
There are multiple sets of criteria used to define periprosthetic joint infection. The objective of this study is to compare the diagnostic accuracy of the calprotectin lateral flow point-of-care ...(POC) test in total knee arthroplasty (TKA) patients to diagnose infection using 3 different sets of criteria: (1) 2013 Musculoskeletal Infection Society, (2) 2018 Intentional Consensus Meeting (ICM), and (3) the 2019 proposed European Bone and Joint Infection Society criteria as reference standards.
From October 2018 to January 2020, 123 intraoperative synovial fluid samples were prospectively collected from revision total knee arthroplasty patients and tested using a calprotectin lateral flow POC assay. Data were reviewed and adjudicated by 2 independent reviewers blinded to calprotectin test results.
The 3 criteria sets had 91.8% agreement. Using 2013 Musculoskeletal Infection Society criteria, the POC test demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.1%, 95.7%, 94.5%, 98.5%, and 0.969, respectively. Using the 2018 ICM, the POC test demonstrated a sensitivity, specificity, PPV, NPV, and AUC of 98.2%, 98.5%, 98.2%, 98.5%, and 0.984, respectively. Using the 2019 proposed European Bone and Joint Infection Society criteria, the POC test demonstrated a sensitivity, specificity, PPV, NPV, and AUC of 93.2%, 100.0%, 100.0%, 94.2%, and 0.966, respectively.
The calprotectin lateral flow POC test had excellent sensitivity and specificity across current available periprosthetic joint infection definitions, with the best performance observed when applying 2018 ICM criteria.
Diagnostic I.
Abstract Numerous plant extracts are abundant in biomolecules that can be employed in the biogenic synthesis of metallic nanoparticles owing to their potent reducing capabilities. The mechanism by ...which biomolecules act as reducers and expedite the reduction of silver ions remains poorly understood. This study presents an instantaneous and environmentally friendly synthesis of silver nanoparticles (AgNPs) using varying concentrations of commercially available green tea and concentrations of a dextrose-reducing solution. The AgNPs formed instantaneously, likely due to the competitive reaction between the polyphenols present in green tea and the dextrose. The best AgNPs produced using a diluted green tea solution at a concentration of 0.05 g of tea/ml and 100 μ l of dextrose solution exhibited high stability over a period of 90 days, as confirmed by UV–vis spectroscopy and dynamic light scattering. The results of antioxidant properties from diluited tea showed 2,2-diphenyl-1-picrylhydrazyl (DPPH) 0.013 ± (0.1) μ mol Trolox Equivalent Anyioxidant Capacity (TEAC) TEAC/g, Ferric Reducing Antioxidant Power (FRAP) 10.3 ± (0.1) μ mol TEAC/g and Total Polyphenol Content (TPC) 0.12 ± (.001) μ gGAE(Galic Acid Equivalent)/g). The resulting nanoparticles are extremely small, measuring approximately 30 to 50 nm in size, and exhibit a spherical morphology as evidenced by SEM imaging. The plasmon bandwidth is better in more diluted tea and higher proportions of dextrose added than the others condition of synthesis. Probably, the results of 2nd extraction of green tea diluted can be evidence that phenolic compounds, mainly, caffeine and gallic acid, are contributing to forming and stabilizing the silver nanoparticles. This fundamental knowledge showed the method employed is ecologically sound and adheres to green principles.
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