Validation and Accuracy of Synovial Alpha Defensin in a Suburban Academic Center after Implantation as Part of the Workup for Periprosthetic Joint infections

Introduction Periprosthetic joint infection (PJI) is a leading cause of total hip and knee arthroplasty failure. The Musculoskeletal Infection Society (MSIS) criteria for PJI has allowed diagnosis standardization. To increase the MSIS criteria accuracy, synovial fluid biomarkers have been tested. Studies evaluating synovial alpha defensin have reported both sensitivity and specificity up to 100%. In this study, we report our analysis on the use of alpha defensin testing in a suburban academic tertiary referral center. Methods We performed a retrospective analysis of a prospectively collected database of 133 patients tested for PJI over a 6 year period. From 2014, our standard infection evaluation protocol included synovial alpha defensin fluid analysis. Complete testing data was available on 128 patients. Both primary and revision total hip and knee arthroplasty were included. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using the 2011 MSIS criteria. T-tests were performed for parametric data. Results Synovial testing of alpha defensin for PJI had a 95.00% sensitivity, a 91.67% specificity, a 67.86% PPV and a 99.00% NPV. Positive alpha defensin tests were corelated with positive serum and synovial CRP, synovial WBC count, and synovial polymorphonuclear cell percent. There was no correlation between positive synovial alpha defensin and age, sex, smoking or diabetic status. Conclusion Synovial testing for alpha defensin in an unbiased cohort gives high sensitivity and NPV comparable to published literature. We recommend using synovial alpha defensin testing for suspected PJI cases, as an additional data point to help determine likelihood

Long-Term Sports Participation and Satisfaction After UCL Reconstruction in Amateur Baseball Players.

Background: While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes. Purpose: To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR. Study Design: Case series; Level of evidence, 4. Methods: We evaluated UCLR patients who were nonprofessional baseball athletes aged(KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire. Results: A total of 91 baseball players met the inclusion criteria, and 67 (74%) patients were available to complete the follow-up surveys at a mean follow-up of 8.9 years (range, 5.5-13.9 years). At the time of the surgery, the mean age was 18.9 ± 1.9 years (range, 15-24 years). Return to play at any level was achieved in 57 (85%) players at a mean time of 12.6 months. Twenty-two (32.8%) of the initial cohort returned to play at the professional level. Also, 43 (79.1%) patients who initially returned to play after surgery reported not playing baseball at the final follow-up; of those patients, 12 reported their elbow as the main reason for eventual retirement. The overall KJOC, MEPS, and T-A scores were 82.8 ± 18.5 (range, 36-100), 96.7 ± 6.7 (range, 75-100), and 91.9 ± 11.4 (range, 50-100), respectively . There was an overall satisfaction score of 90.6 ± 21.5 out of 100, and 64 (95.5%) patients reported that they would undergo UCLR again. Conclusion: In nonprofessional baseball players after UCLR, there was a high rate of progression to higher levels of play. Long-term PRO scores and patient satisfaction were high. The large majority of patients who underwent UCLR would undergo surgery again at long-term follow-up, regardless of career advancement