Journal of Bone and Joint Infection · Published 2026-07-14 · DOI 10.5194/jbji-11-413-2026
Farzad Pourghazi, Seyed Mohammad Amin Alavi, Takahiro Matsuo, Georges Baaklini, Matthew P. Abdel, Aaron J. Tande, Elie F. Berbari
<p><strong>Introduction</strong>: Culture-negative periprosthetic joint infection (CN-PJI) remains a major diagnostic and therapeutic challenge because antimicrobial and surgical management are often empirical. <strong>Methods</strong>: 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. <strong>Results</strong>: 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. <strong>Conclusion</strong>: Overall, CN-PJI may have favorable outcomes, particularly with exchange arthroplasty, but prospective studies with standardized definitions and treatment reporting are needed.</p>
Abstract from DOAJ. Public domain (CC0 1.0).
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Pourghazi, F., Alavi, S., Matsuo, T., et al. (2026). Management and outcomes of culture-negative periprosthetic joint infection: a systematic review and meta-analysis. Journal of Bone and Joint Infection. https://doi.org/10.5194/jbji-11-413-2026