title: [Synovial biomarkers for differential diagnosis of painful arthroplasty].
abstract: BACKGROUND
  The diagnosis and treatment of periprosthetic joint infection (PJI) remain true clinical challenges. PJI diminishes therapeutic success, causes dissatisfaction for the patient and medical staff, and often requires extensive surgical revision(s). At the present time, an extensive multimodal algorithmic approach is used to avoid time- and cost-consuming diagnostic aberrations. However, especially in the case of the frequent and clinically most relevant "low-grade" PJI, the current diagnostic "gold standard" has reached its limits.
  
  
  RESULTS
  Synovial biomarkers are thought to close this diagnostic gap, hopefully enabling the safe differentiation among aseptic, (chronic) septic, implant allergy-related and the arthrofibrotic genesis of symptomatic arthroplasty. Therefore, joint aspiration for obtaining synovial fluid is preferred over surgical synovial tissue biopsy because of the faster results, greater practicability, greater patient safety, and lower costs. In addition to the parameters synovial IL-6, CRP, and leukocyte esterase, novel biomarkers such as antimicrobial peptides and other proinflammatory cytokines are currently highlighted because of their very high to excellent diagnostic accuracy.
  
  
  CONCLUSIONS
  Independent multicenter validation studies are required to show whether a set of different innovative synovial fluid biomarkers rather than a few single parameters is favorable for a safe "one-stop shop" differential diagnosis of PJI.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland. ingo.banke@mri.tum.de.
authors.forename: I J
authors.initials: IJ
authors.lastname: Banke
authors.affiliation: Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Stade
authors.affiliation: Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: P M
authors.initials: PM
authors.lastname: Prodinger
authors.affiliation: Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: H M
authors.initials: HM
authors.lastname: Mühlhofer
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, Frauenlobstraße 9-11, 80337, München, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, Frauenlobstraße 9-11, 80337, München, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Thomas
authors.affiliation: Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, Frauenlobstraße 9-11, 80337, München, Deutschland.
authors.forename: B
authors.initials: B
authors.lastname: Summer
authors.affiliation: Experimentelle Unfallchirurgie, Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: van Griensven
authors.affiliation: Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: von Eisenhart-Rothe
authors.affiliation: Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.|ATOS Klinik München, Effnerstr. 38, 81925, München, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Gollwitzer
mesh_terms: D018771:Arthralgia / Q000175:diagnosis* / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000378:metabolism*; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000378:metabolism*; D013582:Synovial Fluid / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D016207:Cytokines
keywords: Arthritis, infectious; Biological markers; Diagnosis, differential; Periprosthetic joint infection; Synovial fluid