Table 3
Summary of published studies that evaluated the diagnostic accuracy of synovial calprotectin in PJI.
| Study | Warren et al. [53] | Lazic et al. [54] | Xing et al. [55] | Trotter et al. [52] |
|---|---|---|---|---|
| Purpose | Use multiple criteria to compare calprotectin lateral flow POC test diagnosis accuracy in TKA patients | Determine calprotectin’s accuracy in diagnosing PJI with inflammation | Study synovial Calprotectin as a PJI diagnostic test | Test performance of rapid assay for diagnosing PJI using synovial fluid calprotectin |
| Methods | Prospective collection of intraoperative synovial fluid samples from revision TKA patients, tested using calprotectin lateral flow POC assay | Prospective study analyzing synovial WBC, PMC, serum CRP, and synovial calprotectin in patients undergoing primary and revision THA/TKA | Meta-analysis of studies evaluating synovial Calprotectin for PJI diagnosis, adherence to PRISMA guidelines | Comparison of revision patient synovial fluid samples and lateral flow assay calprotectin measurements to ICM 2018 criteria and clinical case review gold standards |
| Results | Excellent sensitivity and specificity across different criteria sets, best performance with 2018 ICM criteria | Calprotectin showed good sensitivity and specificity even in cases with accompanying inflammation | High sensitivity (92%) and specificity (93%) of synovial Calprotectin for PJI diagnosis, along with high diagnostic odds ratio | Calprotectin lateral flow assay had moderate ICM criteria accuracy and improved ICM-CR gold standard accuracy |
| Conclusion | Calprotectin lateral flow POC test is highly sensitive and specific for diagnosing PJI in TKA patients | Calprotectin is reliable for PJI diagnosis even in cases with accompanying inflammation | Synovial Calprotectin is both cost-effective and comparable to other biomarkers for PJI diagnosis | Calprotectin lateral flow assay could be effective for diagnosing PJI, but further prospective studies are needed |
| Pros | Excellent sensitivity and specificity. Potential for improved diagnostic accuracy with 2018 ICM criteria. Point-of-care testing | Good sensitivity and specificity even in cases with accompanying inflammation. Reliability in primary and revision THA/TKA. Promising biomarker for PJI diagnosis | High sensitivity and specificity of synovial Calprotectin. Cost-effective and rapid diagnosis. Comparable to other biomarkers | Potential as a rapid diagnostic tool for PJI. Improvement in accuracy with clinical case review gold standard |
| Cons | Limited sample size. Reliance on retrospective analysis for some criteria sets | Small sample size. Lack of comparison with other biomarkers | Limited to studies using synovial Calprotectin. Potential publication bias in meta-analysis | Average accuracy compared to gold standards. Validation requires more prospective studies |
PPV: positive prognostic value; NPV: negative prognostic value; AUC: area under the ROC curve.
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