Table 2
Comparison of the sensitivity and specificity of the LE POCT with other commonly used infection biomarkers for the diagnosis of PJI.
| Study | Parvizi et al. [35] | Wetters et al. [36] | Shahi et al. [37] | Chen et al. [38] | Aalirezaie et al. [39] | Carli et al. [40] | Kheir et al. [41] | Aggarwal et al. [42] | Li et al. [43] | Li et al. [44] |
|---|---|---|---|---|---|---|---|---|---|---|
| Aim | Determine sensitivity and specificity of leukocyte esterase in diagnosing PJI | Evaluate the diagnostic accuracy of leukocyte esterase reagent strips for diagnosing PJI | Evaluate effects of antibiotic administration on synovial leukocyte esterase strip test for PJI | Assess the diagnostic effectiveness of synovial fluid α-defensin and LE for PJI. | Analyze the diagnostic accuracy of LE strip test for PJI | Compare diagnostic accuracy of various tests for chronic PJI | Determine if LE is a good predictor of persistent infection and/or subsequent failure | Describe a simple, inexpensive, and effective protocol for using centrifugation with LE testing | Investigate the reliability of the LE strip test | Assess the impact of centrifugation on LE strip test results |
| Methods | Prospective study, preoperative and intraoperative synovial fluid analysis | Evaluation of 223 total hip or knee arthroplasties using leukocyte esterase reagent (LER) strips | Retrospective analysis of patients undergoing revision hip or knee arthroplasty | Systematic review and meta-analysis of studies assessing synovial fluid biomarkers for PJI diagnosis | Studies on synovial fluid α-defensin and LE for PJI diagnosis: meta-analysis | Systematic Cochrane review and meta-analysis of chronic PJI diagnostic tests | Prospective analysis of patients undergoing two-stage exchange treatment of PJI | Description of a protocol for using centrifugation with LE testing | Analysis of synovial fluid extracted by joint aspiration applied to LE strips | Analysis of LE strip test results before and after centrifugation |
| Results | ++ reading had 80.6% sensitivity, 100% specificity for PJI diagnosis | Sensitivity: 92.9%, Specificity: 88.8% | Antibiotic administration led to decreased sensitivity of standard tests for PJI diagnosis | LE strip and α-defensin both have high sensitivity and specificity for PJI diagnosis | LE strip test had sensitivity of 85.7%, specificity of 94.4% for PJI diagnosis | Synovial α-defensin tests and LER strips had best performance for diagnosing chronic PJI | LE test sensitivity: 26.3%, Specificity: 100%; MSIS criteria sensitivity: 25.0%, Specificity: 87.3% | LE testing maintained accuracy after centrifugation | Sensitivity: 92.0% (500 threshold), Specificity: 93.1% (500 threshold) | Sensitivity: 97.7% before centrifugation, 92.5% after centrifugation |
| Conclusion | LE esterase in synovial fluid valuable for diagnosing PJI | LER strips rapid, inexpensive, sensitive tool for PJI diagnosis | Antibiotic administration interferes with standard diagnostic tests for PJI diagnosis | LE strip and α-defensin provide rapid and convenient diagnosis for PJI | LE strip test provides rapid, reliable diagnosis for PJI | Synovial fluid-based tests perform well for diagnosing chronic PJI | LE test may be indicative of persistence of infection, higher rate of subsequent failure | LE testing is reliable for diagnosing PJI, even with prior antibiotic administration | LE strip test is an accurate marker for diagnosing PJI | LE strip test results can be influenced by centrifugation |
| Pros | Real-time results, high sensitivity and specificity | Rapid, inexpensive, sensitive tool | Provides insight into effects of antibiotics on diagnostic tests, highlights importance of LE strip test | Rapid and convenient diagnosis, high sensitivity and specificity | Reliable diagnostic tool, high sensitivity and specificity | Perform well for diagnosing chronic PJI, provides comprehensive overview | Provides insight into predictor of infection persistence, helps in subsequent failure prediction | Simple and inexpensive protocol, effective in maintaining accuracy | Excellent sensitivity and specificity, reliable diagnostic tool | Overcomes interference from erythrocytes, maintains sensitivity and specificity |
| Cons | Limited to synovial leukocyte esterase, requires further validation | Limited to cases where synovial fluid is obtained, readability may be affected by blood or debris | Retrospective design, potential bias | Limited to synovial fluid biomarkers, requires further validation | Limited to LE strip test, may not account for all diagnostic markers | Limited to chronic PJI, potential bias in included studies | Limited to two-stage exchange treatment, may not generalize to other treatments | May not generalize to all scenarios, requires validation in broader contexts | Limited to LE strip test, may not account for other diagnostic markers | Influence of centrifugation on results requires consideration |
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