Meta-analysis of synovial fluid polymerase chain reaction for diagnosing periprosthetic hip and knee infection

Background and objective The 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. Methods The 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. Results Eleven 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. Conclusions Synovial fluid PCR provides an effective tool for rapid diagnosis of PJI, and also in the early stages of culture-negative bacterial infections.

Automated summary

This study aimed to assess the diagnostic performance of synovial fluid polymerase chain reaction (PCR) in periprosthetic hip and knee infection and determine its diagnostic significance compared to conventional methods. The results showed that synovial fluid PCR has a high sensitivity and specificity in the rapid diagnosis of periprosthetic joint infection and early-stage culture-negative bacterial infections.