Articles | Volume 10, issue 5
https://doi.org/10.5194/jbji-10-363-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-363-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
10 Oct 2025
Review |
| 10 Oct 2025
| 10 Oct 2025
Serum inflammatory markers for the screening and diagnosis of periprosthetic joint infection: a systematic review and meta-analysis
Irene K. Sigmund
CORRESPONDING AUTHOR
Department of Orthopaedics, Medical University of Vienna, Vienna, Austria
Matthew J. Dietz
Department of Orthopaedics, Health Sciences Center, WVU School of Medicine, Morgantown, WV, USA
Marta Sabater-Martos
Orthopedic and Traumatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
Antony J. R. Palmer
Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
Nicolas Cortés-Penfield
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
A full list of authors appears at the end of the paper.
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Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
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Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
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Long antibiotic courses, including IV and oral administrations, are utilized in prosthetic joint infection (PJI) treatment. Most researchers focus on a shorter duration of the overall antibiotic course for the treatment of PJI; however, this is the first systematic review and meta-analysis to emphasize the IV component of the antibiotic course. The focus on IV treatment only is due to the burden associated with it and its prolonged utilization within the US without much evidence of practice.
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Short summary
Serum C-reactive protein, fibrinogen, and interleukin-6 show the best performance among serum markers for diagnosing periprosthetic joint infection (PJI), but they lack sufficient accuracy to confirm or exclude infection reliably. These markers should be re-evaluated in future PJI definitions, as they are not suitable as stand-alone tests. Given their limitations and the superior diagnostic performance of synovial markers, the role of serum markers in PJI diagnosis should be reconsidered.
Serum C-reactive protein, fibrinogen, and interleukin-6 show the best performance among serum...
