Management and outcomes of culture-negative periprosthetic joint infection: a systematic review and meta-analysis.

Authors

Farzad Pourghazi, Seyed Mohammad Amin Alavi, Takahiro Matsuo, Georges Baaklini, Matthew P Abdel, Aaron J Tande, Elie F Berbari

Published in

Journal of bone and joint infection. Volume 11. Issue 4. Pages 413-430. Epub Jul 14, 2026.

Abstract

Introduction: Culture-negative periprosthetic joint infection (CN-PJI) remains a major diagnostic and therapeutic challenge because antimicrobial and surgical management are often empirical. Methods: We performed a systematic review and meta-analysis to evaluate treatment strategies and outcomes of CN-PJI. MEDLINE and Scopus were searched through 3 July 2025, and 27 cohort studies including 1399 CN-PJI patients were included. Results: Random-effect meta-analyses showed a pooled treatment success proportion of 83.6 % (95 % CI, 78.2-87.9), a pooled failure proportion of 17.2 % (95 % CI, 12.6-22.9), and a pooled mortality proportion of 2.4 % (95 % CI, 1.3-4.6). Subgroup analyses demonstrated lower success and higher failure with debridement, antibiotics, and implant retention compared with one-stage and two-stage exchange arthroplasty. Hip CN-PJI showed higher reported success than knee CN-PJI. Antimicrobial regimens were highly heterogeneous and were not suitable for pooled analysis. Conclusion: Overall, CN-PJI may have favorable outcomes, particularly with exchange arthroplasty, but prospective studies with standardized definitions and treatment reporting are needed.

PMID:
42568959
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.