Abstract
Background and objectiveThe purpose of this study was to estimate the diagnostic performance of synovial fluid polymerase chain reaction (PCR) in periprosthetic hip and knee infection, and whether synovial fluid PCR has greater diagnostic significance than conventional methods.MethodsThe literature databases PubMed, Scopus, and the Web of Science were searched for English articles describing periprosthetic joint infection (PJI) diagnosis by synovial fluid PCR. Articles were limited to the period between January 1990 and December 2019. Subsequently, conventional methods that were used on at least two occasions were included for further analysis. Data analysis was performed using the Meta-DiSc and Stata software.ResultsEleven studies with 1360 cases were included in the meta-analysis. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) of synovial fluid PCR were 0.70 (95% CI 0.66–0.74), 0.92 (95% CI 0.90–0.93), and 37.4 (95% CI 17.77–78.74), respectively.ConclusionsSynovial fluid PCR provides an effective tool for rapid diagnosis of PJI, and also in the early stages of culture-negative bacterial infections.
Highlights
Background and objectiveThe purpose of this study was to estimate the diagnostic performance of synovial fluid polymerase chain reaction (PCR) in periprosthetic hip and knee infection, and whether synovial fluid PCR has greater diagnostic significance than conventional methods
We examined whether synovial fluid PCR has a better diagnostic value compared to conventional methods, especially synovial fluid culture
Two authors (LC and LH) independently selected research papers according to the following inclusion criteria: (1) human studies related to synovial fluid PCR in periprosthetic hip or knee infection; (2) clear description of the diagnosis standard of Periprosthetic joint infection (PJI); and (3) values on truepositive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) were provided or could be computed
Summary
Background and objectiveThe purpose of this study was to estimate the diagnostic performance of synovial fluid polymerase chain reaction (PCR) in periprosthetic hip and knee infection, and whether synovial fluid PCR has greater diagnostic significance than conventional methods. A mixture of several diagnostic methods or diagnostic definition that guide the diagnosis of PJI is currently the most common approach used [7]. Non-microbiological analysis of the synovial fluid white cell count and polymorphonuclear (PMN) leukocytes, alpha-defensin, leukocyte esterase (LE), and C-reactive protein (CRP) were included in the new definition of PJI from the Musculoskeletal Infection Society (MSIS) guideline of 2018 [10]. These tests are of high diagnostic value for PJI cases, they are unable to identify the causative pathogen. A number of reports found that synovial fluid PCR could rapidly
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