Articles | Volume 11, issue 4
https://doi.org/10.5194/jbji-11-479-2026
© Author(s) 2026. 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-11-479-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Culture-negative periprosthetic joint infection: an umbrella review of prevalence, diagnostic strategies, treatment, and methodological limitations
Guido Bocchino
Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 8, 00168, Rome, Italy
Department of Orthopedics, Ageing and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
Institute of Biomechanics, Paracelsus Medical University (PMU), Salzburg, Austria
Giulio Maccauro
Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 8, 00168, Rome, Italy
Department of Orthopedics, Ageing and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
Andrea Zampoli
Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, Rome, Italy
Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Rocco Papalia
Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico, Rome, Italy
Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Pier Francesco Indelli
CORRESPONDING AUTHOR
Institute of Biomechanics, Paracelsus Medical University (PMU), Salzburg, Austria
The Breyer Center for Overseas Studies, Stanford University in Florence, Florence, Italy
University of Trento, School of Medicine, Trento, Italy
Daniel Pérez-Prieto
Orthopedic Department, Septic Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain
Javad Parvizi
International Joint Center, Acibadem University, Istanbul, Türkiye
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Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Ricardo Sousa, Daniel Pérez-Prieto, Alex Soriano, Volker Alt, Willem J. Metsemakers, Martin Clauss, and Rihard Trebse
J. Bone Joint Infect., 11, 651–654, https://doi.org/10.5194/jbji-11-651-2026, https://doi.org/10.5194/jbji-11-651-2026, 2026
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Sinus tracts are currently classified as present or absent in PJI definitions. Although appropriate for diagnosis, this binary approach does not reflect the considerable heterogeneity encountered in clinical practice. This Viewpoint highlights characteristics that may determine sinus tract complexity and proposes a framework for future standardized characterization to better inform surgical decision-making and treatment outcomes.
Ernest Famada Arboix, Arnaud Fischbacher, Matteo Carlo Maria Ferrari, Olivier Borens, and Daniel Pérez-Prieto
J. Bone Joint Infect., 11, 355–361, https://doi.org/10.5194/jbji-11-355-2026, https://doi.org/10.5194/jbji-11-355-2026, 2026
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Gram-negative prosthetic joint infections are challenging. Robust European multicentre data remain limited. This study provides contemporary epidemiological and microbiological data from three tertiary centers across three European countries. We identify patient risk profiles and pathogen-related differences in treatment success. These findings offer novel, practical evidence to guide individualized management of gram-negative prosthetic joint infection (PJI).
Andrea Zampoli, Ghazal Pourbozorg, Goksel Dikmen, Ibrahim Tuncay, and Javad Parvizi
J. Bone Joint Infect., 11, 299–304, https://doi.org/10.5194/jbji-11-299-2026, https://doi.org/10.5194/jbji-11-299-2026, 2026
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Staphylococcus aureus nasal colonization is a key contributor to postoperative infection after hip and knee replacement. We review current evidence on screening and nasal decolonization, highlighting that reliable decolonization is more critical than screening alone. We summarize practical treatment options and propose a simple, standardized preoperative protocol that can be implemented in routine arthroplasty pathways to reduce preventable infections.
Doriana Di Costa, Giacomo Capece, Donato Coppola, Elena Matteini, Pierluigi Del Vecchio, Francesco Taccari, Giuseppe Maccagnano, Carlo Torti, Giulio Maccauro, and Raffaele Vitiello
J. Bone Joint Infect., 11, 277–285, https://doi.org/10.5194/jbji-11-277-2026, https://doi.org/10.5194/jbji-11-277-2026, 2026
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This systematic review evaluates debridement, antibiotic pearls and implant retention (DAPR) as a treatment option for acute periprosthetic joint infection. Analysis of available clinical studies shows encouraging infection control rates with few complications, suggesting that this approach may help to preserve implants in selected patients. However, current evidence is limited, and larger well-designed studies are needed to confirm its effectiveness and clarify its role in clinical practice.
Domenico De Mauro, Chiara Comisi, Valeria Maccauro, Giovanni Balato, Sebastian Meller, Martina Di Martino, Fabiana Arduini, Giulio Maccauro, and Raffaele Vitiello
J. Bone Joint Infect., 11, 139–147, https://doi.org/10.5194/jbji-11-139-2026, https://doi.org/10.5194/jbji-11-139-2026, 2026
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This retrospective study analyzed 682 patients who underwent primary total hip or knee arthroplasty to evaluate the impact of malnutrition on post-operative outcomes. Malnutrition, as defined by the Nutritional Risk Screening 2002 (NRS-2002) and controlling nutritional status (CONUT) scores, was significantly associated with higher rates of post-operative infection and poorer quality-of-life scores. Early nutritional assessment may improve post-operative recovery and reduce complication rates.
Alessandro Singlitico, Daniele Grassa, Rami Kaplan, Alessandro Smimmo, Giulio Maccauro, and Raffaele Vitiello
J. Bone Joint Infect., 10, 85–92, https://doi.org/10.5194/jbji-10-85-2025, https://doi.org/10.5194/jbji-10-85-2025, 2025
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In this article we discuss how gut microbiota can affect the outcomes of a total joint arthroplasty. Total joint arthroplasty is a safe procedure for improving the quality of life in patients affected by arthrosis. Periprosthetic joint infection (PJI) is relatively rare but represents one of the most common causes of implant failure requiring revision surgery. Recently, there has been a major interest in the role of gut microbiome, in particular dysbiosis, as a risk factor for PJI.
Domenico De Mauro, Cesare Meschini, Giovanni Balato, Tiziana Ascione, Enrico Festa, Davide Bizzoca, Biagio Moretti, Giulio Maccauro, and Raffaele Vitiello
J. Bone Joint Infect., 9, 137–142, https://doi.org/10.5194/jbji-9-137-2024, https://doi.org/10.5194/jbji-9-137-2024, 2024
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This study investigates sex-related differences in periprosthetic Joint Infections (PJIs) after total joint arthroplasty. A systematic review of nine studies reveals a higher risk of infectious complications in males compared to females, as indicated by statistically significant findings in half of the studies. This underscores the need for ongoing sex-related analysis to enhance evidence and insights in the field of PJIs.
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
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
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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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Short summary
The current umbrella review showed that prevalence, diagnostic performance of adjunctive molecular methods, treatment strategies, and outcomes vary substantially. Molecular diagnostics appear to be promising as adjunctive tools in selected cases, but their interpretation requires caution, and they do not resolve all uncertainties related to culture-negative periprosthetic joint infections.
The current umbrella review showed that prevalence, diagnostic performance of adjunctive...