The Diagnostic Utility of Synovial Fluid Markers in Periprosthetic Joint Infection: A Systematic Review and Meta-analysis

Introduction: This study is a systematic review of all reported synovial fluid markers for the diagnosis of periprosthetic joint infection and a meta-analysis of the most frequently reported markers to identify those of greatest diagnostic utility. Methods: A search of six databases was conducted to identify all studies evaluating the utility of synovial fluid markers in the diagnosis of periprosthetic joint infection. Two observers assessed methodologic quality and extracted data independently. A metaanalysis of the most frequently reported markers was performed. Results: Twenty-three studies were included in the meta-analysis. The most common markers (and their respective area under the curve) were interleukin-17 (0.974), leukocyte esterase (0.968), alpha-defensin (0.958), interleukin-6 (0.956), interleukin-1 beta (0.948), and C-reactive protein (0.927). Among these markers, alpha-defensin had the highest diagnostic odds ratio but did not achieve statistically significant superiority. Conclusion: The most frequently studied synovial fluid markers for the diagnosis of periprosthetic joint infection are C-reactive protein, leukocyte esterase, interleukin-6, interleukin-1 beta, alpha-defensin, and interleukin-17, all of which have high diagnostic utility.