Ya-Hao Lai1*, Hong Xu1*, Xiao-Yu Li2, Wen-Xuan Zhao2, Ning Lv3, Zong-Ke Zhou1

1Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, China
2Department of Pharmacy, State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
3West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China

Keywords: Arthroplasty, culture, infection, joint, meta-analysis, outcome.


Objectives: This study overviewed the current database of studies on periprosthetic joint infections (PJIs) to compare outcomes and antibiotic side effects in culture-negative or culture-positive PJIs and assess treatment options for culture-negative PJIs.

Patients and methods: A systematic review and meta-analysis was undertaken using studies published before July 2022 in MEDLINE, EMBASE, and Cochrane Library. All studies comparing treatment of culture-negative or -positive PJIs were included. Afterward, the infection control rate, periprosthetic or spacer fracture, hip joint or spacer dislocation, and antibiotic side effects in different treatment methods of PJI were analyzed.

Results: Eleven studies involving 1,747 patients were included. Most studies clearly defined the infection control criteria: no pain or swelling, no wound drainage, normal serology, and normal radiographic findings. Patients were followed until treatment failure, death, or until the last clinical visit without evidence of treatment failure. The two types of PJIs did not differ significantly in infection control rates (culture-negative PJI 79.2% vs. culture-positive PJI 76.6%; odds ratio [OR]=1.20, 95% confidence interval [CI]: 0.84 to 1.70), either after all types of surgical treatment or after two-stage revision arthroplasty (OR=1.12, 95% CI: 0.72 to 1.75), single-stage revision arthroplasty (OR=0.51, 95% CI: 0.19 to 1.37), or debridement, antibiotics, and implant retention (OR=0.88, 95% CI: 0.50 to 1.54). Similarly, we did not find differences in periprosthetic or spacer fracture and hip joint or spacer dislocation. For culture-negative PJIs, the infection control rate was 85.2% after two-stage revision arthroplasty, 90.6% after single-stage revision arthroplasty, and 69.7% after debridement, antibiotics, and implant retention. Data pooled from three studies showed higher incidence of antibiotic side effects for culture-negative PJIs.

Conclusion: The clinical outcomes of one-stage revision and two-stage revision are comparable. Therefore, both of them can be considered in surgical treatment for culture-negative PJIs. In addition, limited data showed a higher incidence of antibiotic side effects in culture-negative PJIs.

* These authors contributed equally to this study

Citation: Lai YH, Xu H, Li XY, Zhao WX, Lv N, Zhou ZK. Outcomes of culture-negative or -positive periprosthetic joint infections: A systematic review and meta-analysis. Jt Dis Relat Surg 2024;35(1):231-241. doi: 10.52312/jdrs.2023.1437.

Author Contributions

Idea/concept, design: Z.Z., Y.L., H.X.; Control/supervision, references and fundings: Z.Z.; Data collection and/or processing: X.L., W.Z.; Analysis and/or interpretation: X.L., N.L.; Literature review: Y.L., H.X.; Writing the article: Y.L.; Critical review: H.X.; Materials: Y.L., H.X.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

This work was supported by the National Key R&D Program of China (grant No. 2022YFC2503104) and National Natural Science Foundation of China (grant No. 82172394, U22A20280).

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.