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This study aimed to evaluate and unify their diagnostic accuracy and the threshold selection of serum and synovial routine tests for PJI at an early stage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched the MEDLINE and Embase databases for retrospective or prospective studies which reported preoperative\u2010available assays (serum, synovial, or culture tests) for the diagnosis of chronic PJI among inflammatory arthritis (IA) or non\u2010IA populations from January 1, 2000 to June 30, 2022. Threshold effective analysis was performed on synovial polymorphonuclear neutrophils (PMN%), synovial white blood cell (WBC), serum C\u2010reactive protein (CRP), and erythrocyte sedimentation rate (ESR) to find the relevant cut\u2010offs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Two hundred and sixteen studies and information from 45,316 individuals were included in the final analysis. Synovial laboratory\u2010based \u03b1\u2010defensin and calprotectin had the best comprehensive sensitivity (0.91 [0.86\u20130.94], 0.95 [0.88\u20130.98]) and specificity (0.96 [0.94\u20100.97], 0.95 [0.89\u20130.98]) values. According to the threshold effect analysis, the recommended cut\u2010offs are 70% (sensitivity 0.89 [0.85\u20130.92], specificity 0.90 [0.87\u20130.93]), 4100\/\u03bcL (sensitivity 0.90 [0.87\u20130.93], specificity 0.97 [0.93\u20130.98]), 13.5\u2009mg\/L (sensitivity 0.84 [0.78\u20130.89], specificity 0.83 [0.73\u20130.89]), and 30\u2009mm\/h (sensitivity 0.79 [0.74\u20130.83], specificity 0.78 [0.72\u20130.83]) for synovial PMN%, synovial WBC, serum CRP, and ESR, respectively, and tests seem to be more reliable among non\u2010IA patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The laboratory\u2010based synovial \u03b1\u2010defensin and synovial calprotectin are the two best independent preoperative diagnostic tests for PJI. A cut off of 70% for synovial PMN% and tighter cut\u2010offs for synovial WBC and serum CRP could have a better diagnostic accuracy for non\u2010IA patients with chronic PJI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.13500","type":"journal-article","created":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T03:10:40Z","timestamp":1664593840000},"page":"2822-2836","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Reliable Diagnostic Tests and Thresholds for Preoperative Diagnosis of Non\u2010Inflammatory Arthritis Periprosthetic Joint Infection: A Meta\u2010analysis and Systematic Review"],"prefix":"10.1111","volume":"14","author":[{"given":"Haozheng","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialian","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei'en","family":"Yuan","sequence":"additional","affiliation":[{"name":"Ministry of Education Engineering Research Center of Cell &amp; Therapeutic Antibody School of Pharmacy, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8889-0890","authenticated-orcid":false,"given":"Xinhua","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Bone and Joint Surgery, Department of Orthopedics Renji Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.18.00632"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.00123"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-2102-9"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.03.009"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis966"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B11.33135"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2018.03.017"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-018-3865-3"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.12.018"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2018.08.022"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.17.01429"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2019.06.044"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.02.078"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.09.044"},{"key":"e_1_2_7_16_1","unstructured":"Cochrane Methods.Cochrane Handbook for DTA Reviews.2013. 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