{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:44:55Z","timestamp":1787755495778,"version":"build-2784847793"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Our objective was to identify combination tests used to diagnose chronic periprosthetic joint infection (PJI) and develop a stepwise decision-making tool to facilitate diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a systematic review of existing combinations of serum, synovial, and tissue-based tests for diagnosing chronic PJI after hip or knee replacement. This work is an extension of our systematic review of single tests, from which we chose eligible studies that also described the diagnostic performance of combination tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Thirty-seven eligible articles described the performance of 56 combination tests, of which 8 combinations had at least 2 studies informing both sensitivity and specificity. We also identified 5 types of combination tests: (1) a type-I Boolean combination, which uses Boolean logic (AND, OR) and usually increases specificity at the cost of sensitivity; (2) a type-II Boolean combination, which usually increases sensitivity at the cost of specificity; (3) a triage-conditional rule, in which the value of 1 test serves to triage the use of another test; (4) an arithmetic operation on the values of 2 tests; and (5) a model-based prediction rule based on a fitted model applied to biomarker values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Clinicians can initiate their diagnostic process with a type-II Boolean combination of serum C-reactive protein (CRP) and interleukin-6 (IL-6). False negatives of the combination can be minimized when the threshold is chosen to reach 90% to 95% sensitivity for each test. Once a joint infection is suspected on the basis of serum testing, joint aspiration should be performed. If joint aspiration yields a wet tap, a leukocyte esterase (LER) strip is highly recommended for point-of-care testing, with a reading of ++ or greater indicating PJI; a reading below ++ should be followed by one of the laboratory-based synovial tests. If joint aspiration yields a dry tap, clinicians should rely on preoperative tissue culture and histological analysis for diagnosis. Combinations based on triage-conditional, arithmetic, and model-based prediction rules require further research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Diagnostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.20.00097","type":"journal-article","created":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T16:00:55Z","timestamp":1598457655000},"page":"114-124","source":"Crossref","is-referenced-by-count":12,"title":["Combination Tests in the Diagnosis of Chronic Periprosthetic Joint Infection"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3025-0775","authenticated-orcid":false,"given":"Hesham","family":"Abdelbary","sequence":"first","affiliation":[{"name":"Division of Orthopaedic Surgery (H.A. and P.E.B.) and School of Epidemiology and Public Health (B.J.S. and B.H.), University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1475-4079","authenticated-orcid":false,"given":"Wei","family":"Cheng","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8180-1568","authenticated-orcid":false,"given":"Nadera","family":"Ahmadzai","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3129-705X","authenticated-orcid":false,"given":"Alberto V.","family":"Carli","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7686-2585","authenticated-orcid":false,"given":"Beverley J.","family":"Shea","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery (H.A. and P.E.B.) and School of Epidemiology and Public Health (B.J.S. and B.H.), University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5662-8647","authenticated-orcid":false,"given":"Brian","family":"Hutton","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery (H.A. and P.E.B.) and School of Epidemiology and Public Health (B.J.S. and B.H.), University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3389-2485","authenticated-orcid":false,"given":"Dean A.","family":"Fergusson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7667-9994","authenticated-orcid":false,"given":"Paul E.","family":"Beaul\u00e9","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery (H.A. and P.E.B.) and School of Epidemiology and Public Health (B.J.S. and B.H.), University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,6,26]]},"reference":[{"issue":"24","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.2106\/JBJS.L.00789","article-title":"Periprosthetic joint infection increases the risk of one-year mortality","volume":"95","author":"Zmistowski","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"1","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1503\/cjs.008617","article-title":"Tertiary care centre adherence to unified guidelines for management of periprosthetic joint infections: a gap analysis","volume":"61","author":"Armstrong","year":"2018","journal-title":"Can J Surg."},{"issue":"11","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"3022","DOI":"10.1007\/s11999-011-1971-2","article-title":"Definition of periprosthetic joint infection: is there a consensus?","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"635","DOI":"10.2106\/JBJS.18.00632","article-title":"Diagnostic accuracy of serum, synovial, and tissue testing for chronic periprosthetic joint infection after hip and knee replacements: a systematic review","volume":"101","author":"Carli","year":"2019","journal-title":"J Bone Joint Surg Am."},{"issue":"11","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1302\/0301-620X.95B11.33135","article-title":"Proceedings of the International Consensus on Periprosthetic Joint Infection","volume":"95-B","author":"Parvizi","year":"2013","journal-title":"Bone Joint J."},{"issue":"5","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","article-title":"The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria","volume":"33","author":"Parvizi","year":"2018","journal-title":"J Arthroplasty."},{"issue":"14","key":"bib7-20230714","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.2106\/JBJS.9314ebo","article-title":"American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee","volume":"93","author":"Della Valle","year":"2011","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib9-20230714","doi-asserted-by":"crossref","first-page":"3263","DOI":"10.1007\/s11999-010-1451-0","article-title":"Combining C-reactive protein and interleukin-6 may be useful to detect periprosthetic hip infection","volume":"468","author":"Buttaro","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1007\/s00264-014-2475-y","article-title":"Interleukin-6 and other inflammatory markers in diagnosis of periprosthetic joint infection","volume":"38","author":"Elgeidi","year":"2014","journal-title":"Int Orthop."},{"issue":"1","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1302\/0301-620X.89B1.17485","article-title":"Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement","volume":"89","author":"Bottner","year":"2007","journal-title":"J Bone Joint Surg Br."},{"issue":"8","key":"bib12-20230714","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.1007\/s11999-013-2998-3","article-title":"Novel biomarkers to detect infection in revision hip and knee arthroplasties","volume":"471","author":"Glehr","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"e102346","DOI":"10.1371\/journal.pone.0102346","article-title":"Utility of intraoperative frozen section in the diagnosis of periprosthetic joint infection","volume":"9","author":"Wu","year":"2014","journal-title":"PLoS One."},{"issue":"6","key":"bib14-20230714","doi-asserted-by":"crossref","first-page":"e0199226","DOI":"10.1371\/journal.pone.0199226","article-title":"Serum IL-6 in combination with synovial IL-6\/CRP shows excellent diagnostic power to detect hip and knee prosthetic joint infection","volume":"13","author":"Gallo","year":"2018","journal-title":"PLoS One."},{"issue":"6","key":"bib15-20230714","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1007\/s00167-017-4745-x","article-title":"High performance of \u03b1-defensin lateral flow assay (Synovasure) in the diagnosis of chronic knee prosthetic infections","volume":"26","author":"Balato","year":"2018","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"6","key":"bib16-20230714","doi-asserted-by":"crossref","first-page":"1904","DOI":"10.1016\/j.arth.2018.01.072","article-title":"Puncture protocol in the diagnostic work-up of a suspected chronic prosthetic joint infection of the hip","volume":"33","author":"Ottink","year":"2018","journal-title":"J Arthroplasty."},{"issue":"6","key":"bib17-20230714","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1007\/s00402-018-2924-y","article-title":"Preoperative PCR analysis of synovial fluid has limited value for the diagnosis of periprosthetic joint infections of total knee arthroplasties","volume":"138","author":"Fink","year":"2018","journal-title":"Arch Orthop Trauma Surg."},{"issue":"4","key":"bib18-20230714","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/j.arth.2017.11.006","article-title":"Synovial calprotectin: an inexpensive biomarker to exclude a chronic prosthetic joint infection","volume":"33","author":"Wouthuyzen-Bakker","year":"2018","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib19-20230714","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00402-017-2832-6","article-title":"Diagnostic accuracy of synovial fluid, blood markers, and microbiological testing in chronic knee prosthetic infections","volume":"138","author":"Balato","year":"2018","journal-title":"Arch Orthop Trauma Surg."},{"issue":"1","key":"bib20-20230714","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1186\/s12879-017-2693-1","article-title":"Accuracy of different diagnostic tests for early, delayed and late prosthetic joint infection","volume":"17","author":"Fern\u00e1ndez-Sampedro","year":"2017","journal-title":"BMC Infect Dis."},{"issue":"9","key":"bib21-20230714","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1302\/0301-620X.99B9.BJJ-2016-1345.R2","article-title":"Diagnosis of prosthetic joint infection with alpha-defensin using a lateral flow device: a multicentre study","volume":"99-B","author":"Berger","year":"2017","journal-title":"Bone Joint J."},{"issue":"1","key":"bib22-20230714","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40001-017-0246-0","article-title":"Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip","volume":"22","author":"Pohlig","year":"2017","journal-title":"Eur J Med Res."},{"issue":"3","key":"bib23-20230714","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1302\/0301-620X.99B3.BJJ-2016-0684.R1","article-title":"Improving the accuracy of synovial fluid analysis in the diagnosis of prosthetic joint infection with simple and inexpensive biomarkers: C-reactive protein and adenosine deaminase","volume":"99-B","author":"Sousa","year":"2017","journal-title":"Bone Joint J."},{"issue":"12","key":"bib24-20230714","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1007\/s00402-016-2574-x","article-title":"The value of arthroscopic neosynovium biopsies to diagnose periprosthetic knee joint low-grade infection","volume":"136","author":"Claassen","year":"2016","journal-title":"Arch Orthop Trauma Surg."},{"issue":"2","key":"bib25-20230714","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.arth.2013.06.020","article-title":"Correlation of aspiration results with periprosthetic sepsis in revision total hip arthroplasty","volume":"29","author":"Chalmers","year":"2014","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib26-20230714","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s00256-013-1757-6","article-title":"Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty","volume":"43","author":"Cross","year":"2014","journal-title":"Skeletal Radiol."},{"issue":"5","key":"bib27-20230714","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1007\/s00264-013-1853-1","article-title":"Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection","volume":"37","author":"Janz","year":"2013","journal-title":"Int Orthop."},{"issue":"7","key":"bib28-20230714","doi-asserted-by":"crossref","first-page":"644","DOI":"10.2106\/JBJS.L.00205","article-title":"Antimicrobial peptides and proinflammatory cytokines in periprosthetic joint infection","volume":"95","author":"Gollwitzer","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib29-20230714","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1007\/s11999-012-2474-5","article-title":"High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip","volume":"471","author":"Fink","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib30-20230714","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.arth.2012.03.059","article-title":"Periprosthetic joint infection diagnosis: a complete understanding of white blood cell count and differential","volume":"27","author":"Zmistowski","year":"2012","journal-title":"J Arthroplasty."},{"issue":"8","key":"bib31-20230714","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.arth.2012.03.021","article-title":"Serum white blood cell count and differential do not have a role in the diagnosis of periprosthetic joint infection","volume":"27","author":"Toossi","year":"2012","journal-title":"J Arthroplasty."},{"issue":"4","key":"bib32-20230714","first-page":"160","article-title":"Efficacy of erythrocyte sedimentation rate and C-reactive protein level in determining periprosthetic hip infections","volume":"41","author":"Costa","year":"2012","journal-title":"Am J Orthop (Belle Mead NJ)."},{"issue":"11","key":"bib33-20230714","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1007\/s00264-010-1175-5","article-title":"Serological markers can lead to false negative diagnoses of periprosthetic infections following total knee arthroplasty","volume":"35","author":"Johnson","year":"2011","journal-title":"Int Orthop."},{"issue":"5","key":"bib34-20230714","doi-asserted-by":"crossref","first-page":"1410","DOI":"10.1007\/s11999-010-1245-4","article-title":"Is there a role for tissue biopsy in the diagnosis of periprosthetic infection?","volume":"468","author":"Meermans","year":"2010","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib35-20230714","doi-asserted-by":"crossref","first-page":"e444","DOI":"10.1016\/j.ijid.2009.02.017","article-title":"The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty","volume":"13","author":"Ghanem","year":"2009","journal-title":"Int J Infect Dis."},{"issue":"9","key":"bib36-20230714","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.2106\/JBJS.G.01255","article-title":"Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty","volume":"90","author":"Schinsky","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib37-20230714","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.2106\/JBJS.G.00470","article-title":"Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty","volume":"90","author":"Ghanem","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib38-20230714","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1302\/0301-620X.90B7.20417","article-title":"The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements","volume":"90","author":"Fink","year":"2008","journal-title":"J Bone Joint Surg Br."},{"issue":"1","key":"bib39-20230714","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.arth.2007.09.005","article-title":"A simple, cost-effective screening protocol to rule out periprosthetic infection","volume":"23","author":"Austin","year":"2008","journal-title":"J Arthroplasty."},{"issue":"17","key":"bib40-20230714","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.2106\/JBJS.M.01316","article-title":"Combined measurement of synovial fluid \u03b1-defensin and C-reactive protein levels: highly accurate for diagnosing periprosthetic joint infection","volume":"96","author":"Deirmengian","year":"2014","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib41-20230714","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/cid\/civ286","article-title":"Circulating biomarkers for discrimination between aseptic joint failure, low-grade infection, and high-grade septic failure","volume":"61","author":"Ettinger","year":"2015","journal-title":"Clin Infect Dis."},{"issue":"10","key":"bib42-20230714","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1007\/s00264-014-2351-9","article-title":"Lipopolysaccharide-binding protein: a valuable biomarker in the differentiation between periprosthetic joint infection and aseptic loosening?","volume":"38","author":"Friedrich","year":"2014","journal-title":"Int Orthop."},{"issue":"7","key":"bib43-20230714","doi-asserted-by":"crossref","first-page":"e0131609","DOI":"10.1371\/journal.pone.0131609","article-title":"The suspected infected prosthetic joint: clinical acumen and added value of laboratory investigations","volume":"10","author":"Petti","year":"2015","journal-title":"PLoS One."},{"issue":"5","key":"bib44-20230714","doi-asserted-by":"crossref","first-page":"672","DOI":"10.2106\/00004623-199905000-00008","article-title":"Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties","volume":"81","author":"Spangehl","year":"1999","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib45-20230714","doi-asserted-by":"crossref","first-page":"e89045","DOI":"10.1371\/journal.pone.0089045","article-title":"Interleukin-6 in serum and in synovial fluid enhances the differentiation between periprosthetic joint infection and aseptic loosening","volume":"9","author":"Randau","year":"2014","journal-title":"PLoS One."},{"issue":"3","key":"bib46-20230714","doi-asserted-by":"crossref","first-page":"ofv098","DOI":"10.1093\/ofid\/ofv098","article-title":"Acute phase reactants in infections: evidence-based review and a guide for clinicians","volume":"2","author":"Markanday","year":"2015","journal-title":"Open Forum Infect Dis."},{"issue":"10","key":"bib47-20230714","doi-asserted-by":"crossref","first-page":"2454","DOI":"10.1016\/j.arth.2019.05.009","article-title":"Plasma fibrin degradation product and D-dimer are of limited value for diagnosing periprosthetic joint infection","volume":"34","author":"Xu","year":"2019","journal-title":"J Arthroplasty."},{"issue":"11","key":"bib48-20230714","doi-asserted-by":"crossref","first-page":"2730","DOI":"10.1016\/j.arth.2019.06.016","article-title":"Development and validation of an evidence-based algorithm for diagnosing periprosthetic joint infection","volume":"34","author":"Shohat","year":"2019","journal-title":"J Arthroplasty."},{"issue":"24","key":"bib49-20230714","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.2106\/JBJS.17.00123","article-title":"Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis","volume":"99","author":"Lee","year":"2017","journal-title":"J Bone Joint Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:00Z","timestamp":1787751840000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.00097"}},"subtitle":["Systematic Review and Development of a Stepwise Clinical Decision-Making Tool"],"short-title":[],"issued":{"date-parts":[[2020,6,26]]},"references-count":48,"journal-issue":{"issue":"Suppl 2","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.20.00097","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,26]]}}}