Preop Biomarkers as Outcome Predictors in 2 Stage Revision Surgery for PJI

Official title

Identification of Pre-prosthetic Revision Markers Predictive of Outcome in Patients With Periprosthetic Infection

Overview

With the progressive ageing of the population, a significant increase in the incidence of skeletal fractures-particularly of the proximal femur-as well as degenerative conditions such as osteoarthritis has been observed, for which joint arthroplasty represents the treatment of choice. However, this procedure is not free from complications; beyond technical and mechanical issues related to potential implant malpositioning, one of the most feared is periprosthetic joint infection (PJI), which poses a major challenge in terms of clinical management and prognostic impact. Therapeutic strategies for PJI range from debridement with retention of the implant and exchange of modular components (DAIR/DAPRI) to complete implant removal with insertion of an articulating spacer, often followed by a subsequent reimplantation procedure. These approaches require prolonged antibiotic regimens, potentially exerting a negative effect on renal function, particularly in cases of extended exposure to nephrotoxic agents. Despite the clinical relevance of this issue, the current literature still provides limited evidence regarding the identification of inexpensive and readily available biomarkers capable of predicting treatment outcomes in PJI, especially in patients undergoing spacer implantation followed by reimplantation. Recent literature has increasingly explored the use of biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and others to characterize inflammatory and nutritional status, and to investigate possible associations between these markers and the outcomes of selected surgical procedures. The availability of predictive markers could optimize therapeutic management by reducing the risk of infection recurrence and improving postoperative risk stratification.

Primary outcome measures

• Biomarkers' capacity to predict the likelihood of prosthetic reimplantation [Time frame: From enrollment for at least one year]

Secondary outcome measures (3)

• Acute kidney injury [Time frame: From enrollment for at least one year]
• ADL/IADL [Time frame: From enrollment for at least one year]
• SF-12 [Time frame: From enrollment for at least one year]

Eligibility criteria

Inclusion criteria

• Age ≥ 18 years
• Diagnosis of an orthopaedic periprosthetic joint infection (PJI)
• Surgical treatment
• Minimum follow-up of 12 months
• Written informed consent to participate in the study

Exclusion criteria

• Age < 18 years
• Patients undergoing prosthetic revision without evidence of periprosthetic joint infection
• Treatment with antibiotic therapy alone (non-surgical management)
• Follow-up < 12 months
• Incomplete dataset
• Lack of informed consent to participate in the study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Cohort

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Tarabichi S, Lizcano JD, Abe EA, Goh GS, Baker CM, Parvizi J. Finding the Optimal Screening Test for Periprosthetic Joint Infection: A Prospective Study. J Arthroplasty. 2024 Aug;39(8):1919-1925.e2. doi: 10.1016/j.arth.2024.02.030. Epub 2024 Mar 6. PMID 38452860
• Jones IA, Wier J, Chen MS, Liu KC, Palmer R, Mayfield CK, Heckmann ND. Complete Blood Count Ratios Predict Adverse Events After Total Joint Arthroplasty. J Am Acad Orthop Surg. 2024 Dec 15;32(24):e1315-e1323. doi: 10.5435/JAAOS-D-24-00184. Epub 2024 Jun 6. PMID 38861722
• Balato G, Ascione T, Festa E, Di Gennaro D, Pandolfo G, Pagliano P. The Diagnostic Accuracy of Neutrophils to Lymphocytes Ratio, Platelets to Lymphocytes Ratio, Monocytes to Lymphocytes Ratio, and Platelets to Mean Platelet Volume Ratio in Diagnosing Periprosthetic Knee Infections. Are Gender-Specific Cutoff Values Needed? J Arthroplasty. 2023 May;38(5):918-924. doi: 10.1016/j.arth.2022.11.014. Ep PMID 36481284
• Ascione T, Balato G, Pagliano P. Upcoming evidence in clinical practice of two-stage revision arthroplasty for prosthetic joint infection. J Orthop Traumatol. 2024 May 18;25(1):26. doi: 10.1186/s10195-024-00767-1. PMID 38761247
• Zhang QY, Li HX, Xie HQ, Liu LM, Chen L, Zeng Y. Identifying potential predictive indicators for reimplantation timing in two-stage revision: a meta-analysis and system review. Arch Orthop Trauma Surg. 2024 Dec 23;145(1):88. doi: 10.1007/s00402-024-05689-5. PMID 39714508
• Karlidag T, Zanna L, Mundhe A, Gehrke T, Citak M. Admission Lymphocyte-to-C-Reactive Protein Ratio Predicts 90-Day Adverse Outcomes Following Aseptic Revision Total Hip Arthroplasty. J Arthroplasty. 2025 Nov 7:S0883-5403(25)01430-5. doi: 10.1016/j.arth.2025.11.004. Online ahead of print. PMID 41207340
• Muscaritoli M, Molfino A, Orlando S, Tambaro F. Assessing systemic inflammation and its prognostic value: Glasgow Prognostic Score, neutrophil-to-lymphocyte ratio or other options? Curr Opin Clin Nutr Metab Care. 2025 Sep 1;28(5):367-372. doi: 10.1097/MCO.0000000000001151. Epub 2025 Aug 1. PMID 40772508
• Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018 May;33(5):1309-1314.e2. doi: 10.1016/j.arth.2018.02.078. Epub 2018 Feb 26. PMID 29551303

Identifiers

NCT: NCT07358455 · 7818

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗