{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:12Z","timestamp":1787755272920,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,1,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Alpha defensin is a new biomarker that has been shown to have a very high accuracy to rule out periprosthetic joint infection. Recently, a new rapid lateral flow version of the alpha defensin test was developed and introduced to detect high levels of alpha defensin in synovial fluid quickly and with ease. We conducted a single-center prospective clinical study to compare the results of the Synovasure Alpha Defensin Test with those of the Musculoskeletal Infection Society (MSIS) criteria, which are considered to be the gold standard for diagnosing periprosthetic joint infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 223 consecutive patients with pain after total hip arthroplasty or total knee arthroplasty were enrolled into the study. In all patients, blood C-reactive protein was measured and joint aspirations were performed. From the synovial fluid, a leukocyte cell count with granulocyte percentage, microbiology cultures, and leukocyte esterase tests were carried out according to the recommendation of the MSIS for diagnosing periprosthetic joint infection. Concurrently, the Synovasure Alpha Defensin Test with a lateral flow device was performed from the aspirate. In the final clinical and statistical evaluation, 191 subjects with 195 joint aspirations (96 hips and 99 knees) were included. According to the MSIS criteria, there were 119 joints with an aseptic revision and 76 joints with periprosthetic joint infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>After statistical analysis, the overall sensitivity of the Synovasure Alpha Defensin Test was 92.1% (95% confidence interval [CI], 83.6% to 97.1%), the specificity was 100% (95% CI, 97.0% to 100%), the positive predictive value was 100% (95% CI, 94.9% to 100%), and the negative predictive value was 95.2% (95% CI, 89.9% to 98.2%). The overall accuracy of the Synovasure test was 96.9% (95% CI, 93.4% to 98.9%), 189 of 195 cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our results suggest that the Synovasure periprosthetic joint infection test has a very high accuracy in diagnosing periprosthetic infections after total hip arthroplasty or total knee arthroplasty. Although the Synovasure Alpha Defensin Test does not provide information on the identity of the infectious pathogen, the test does have an important role in recognizing periprosthetic joint infection early and enables surgeons to start proper therapy without delay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Diagnostic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.01522","type":"journal-article","created":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T20:24:43Z","timestamp":1515097483000},"page":"42-48","source":"Crossref","is-referenced-by-count":104,"title":["The Accuracy of the Alpha Defensin Lateral Flow Device for Diagnosis of Periprosthetic Joint Infection"],"prefix":"10.2106","volume":"100","author":[{"given":"Thorsten","family":"Gehrke","sequence":"first","affiliation":[{"name":"Helios ENDO-Klinik Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Lausmann","sequence":"additional","affiliation":[{"name":"Helios ENDO-Klinik Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Citak","sequence":"additional","affiliation":[{"name":"Helios ENDO-Klinik Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Bonanzinga","sequence":"additional","affiliation":[{"name":"Helios ENDO-Klinik Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Frommelt","sequence":"additional","affiliation":[{"name":"Helios ENDO-Klinik Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-4415","authenticated-orcid":false,"given":"Akos","family":"Zahar","sequence":"additional","affiliation":[{"name":"Helios ENDO-Klinik Hamburg, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"8","key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1056\/NEJMcp0905029","article-title":"Clinical practice. Infection associated with prosthetic joints","volume":"361","author":"Del Pozo","year":"2009","journal-title":"N Engl J Med."},{"issue":"11","key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib3-20230811","doi-asserted-by":"crossref","first-page":"3254","DOI":"10.1007\/s11999-014-3543-8","article-title":"Diagnosing periprosthetic joint infection: has the era of the biomarker arrived?","volume":"472","author":"Deirmengian","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"17","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.2106\/JBJS.M.01316","article-title":"Combined measurement of synovial fluid \u03b1-defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection","volume":"96","author":"Deirmengian","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"2017","DOI":"10.1007\/s11999-010-1298-4","article-title":"Synovial fluid biomarkers for periprosthetic infection","volume":"468","author":"Deirmengian","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s11999-014-3722-7","article-title":"The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip","volume":"473","author":"Deirmengian","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"4","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1172\/JCI112120","article-title":"Defensins. Natural peptide antibiotics of human neutrophils","volume":"76","author":"Ganz","year":"1985","journal-title":"J Clin Invest."},{"issue":"7","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1007\/s11999-015-4152-x","article-title":"The alpha-defensin test for periprosthetic joint infection responds to a wide spectrum of organisms","volume":"473","author":"Deirmengian","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1007\/s11999-016-4906-0","article-title":"How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study","volume":"475","author":"Bonanzinga","year":"2017","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib10-20230811","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1302\/0301-620X.95B11.32646","article-title":"One-stage exchange: it all began here","volume":"95-B","author":"Gehrke","year":"2013","journal-title":"Bone Joint J."},{"issue":"3","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.ocl.2016.03.001","article-title":"Diagnosis of periprosthetic joint infection following hip and knee arthroplasty","volume":"47","author":"Parvizi","year":"2016","journal-title":"Orthop Clin North Am."},{"issue":"12","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"4006","DOI":"10.1007\/s11999-014-3900-7","article-title":"The alpha defensin-1 biomarker assay can be used to evaluate the potentially infected total joint arthroplasty","volume":"472","author":"Bingham","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1016\/j.arth.2016.05.033","article-title":"Intraoperative diagnosis of periprosthetic joint infection using a novel alpha-defensin lateral flow assay","volume":"31","author":"Kasparek","year":"2016","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib14-20230811","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.arth.2015.09.035","article-title":"\u03b1-defensin accuracy to diagnose periprosthetic joint infection-best available test?","volume":"31","author":"Frangiamore","year":"2016","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib15-20230811","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1007\/s00264-014-2449-0","article-title":"Excluding infections in arthroplasty using leucocyte esterase test","volume":"38","author":"Guenther","year":"2014","journal-title":"Int Orthop."},{"issue":"12","key":"bib16-20230811","doi-asserted-by":"crossref","first-page":"992","DOI":"10.2106\/JBJS.15.01142","article-title":"The alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of periprosthetic infection: a systematic review and meta-analysis","volume":"98","author":"Wyatt","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1007\/s00264-016-3306-0","article-title":"Alpha-defensin-novel synovial fluid biomarker for the diagnosis of periprosthetic joint infection","volume":"40","author":"Pupaibool","year":"2016","journal-title":"Int Orthop."},{"issue":"4","key":"bib18-20230811","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1016\/j.arth.2016.10.001","article-title":"Procalcitonin and \u03b1-defensin for diagnosis of periprosthetic joint infections","volume":"32","author":"Xie","year":"2017","journal-title":"J Arthroplasty."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201801030-00006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:29Z","timestamp":1787751629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201801030-00006"}},"subtitle":["Comparison with a Gold Standard"],"short-title":[],"issued":{"date-parts":[[2018,1,3]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.01522","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,3]]}}}