Work

Is synovial calprotectin lateral flow test a reliable intraoperative biomarker for periprosthetic joint infection? A systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: INTRODUCTION: Periprosthetic Joint Infection (PJI) remains one of the most challenging complications in arthroplasty, often leading to diagnostic uncertainty and suboptimal treatment decisions. Synovial calprotectin has emerged as a promising biomarker, with the lateral flow test (LFT) offering real-time results for intraoperative decision-making. This meta-analysis aimed to evaluate the diagnostic accuracy of intraoperative synovial calprotectin LFT in detecting PJI. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Thirteen studies comprising 990 patients were included. Pooled sensitivity, specificity, positive and negative predictive values (PPV, NPV), likelihood ratios (LR+, LR−), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using a random-effects model. Subgroup analyses were performed based on test kit type and calprotectin cutoff values. RESULTS: The pooled sensitivity and specificity of synovial calprotectin LFT were 88% (95% CI: 82–92%) and 89% (95% CI: 83–93%), respectively, with an AUC of 0.94. The DOR was 56.1 (95% CI: 28.4-110.8). The ≥ 50 mg/L cutoff subgroup demonstrated superior diagnostic performance across all metrics. Despite subgroup analysis, heterogeneity remained high (I² = 74.1%), likely due to differences in reference standards, joint types, and study design. CONCLUSIONS: Intraoperative synovial calprotectin LFT is a highly accurate and rapid diagnostic tool for PJI, with strong applicability in real-world surgical settings. Its cost-effectiveness and ease of use support its integration as a valuable adjunctive marker within standard diagnostic algorithms, providing supplementary evidence when conventional criteria remain inconclusive.

Source: Archives of Orthopaedic and Trauma Surgery

DOI: 10.1007/s00402-026-06202-w

Authors: Konstantinos Giatroudakis, Efthymios Iliopoulos, Konstantinos Kateros, Athanasios Ververidis

Institutions: Democritus University of Thrace, General Hospital of Athens G. Genimatas, University Hospital of Alexandroupolis

Language: English

Topic: Orthopedic Infections and Treatments

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,590