{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:13:46Z","timestamp":1789625626845,"version":"build-2803163510"},"reference-count":77,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty (TJA), with treatment failure occurring in 12% to 28% after 2-stage revision. It is vital to identify diagnostic tools indicative of persistent infection or treatment failure after 2-stage revision for PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The Cochrane Library, PubMed (MEDLINE), and EMBASE were searched for randomized controlled trials and comparative observational studies published before October 3, 2021, which evaluated the utility of serum\/plasma biomarkers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], interleukin-6 [IL-6], fibrinogen, D-dimer), synovial biomarkers (white blood cell [WBC] count, neutrophil percentage [PMN %], alpha-defensin [AD], leukocyte esterase [LE]), tissue frozen section, tissue culture, synovial fluid culture, or sonicated spacer fluid culture indicative of persistent infection before the second stage of 2-stage revision for PJI or treatment failure after 2-stage revision for PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 47 studies including 6,605 diagnostic tests among 3,781 2-stage revisions for PJI were analyzed. Among those cases, 723 (19.1%) experienced persistent infection or treatment failure. Synovial LE (sensitivity 0.25 [0.10-0.47], specificity 0.99 [0.93-1.00], positive likelihood ratio 14.0 [1.45-135.58]) and serum IL-6 (sensitivity 0.52 [0.33-0.70], specificity 0.92 [0.85-0.96], positive likelihood ratio 7.90 [0.86-72.61]) had the highest diagnostic accuracy. However, no biomarker was associated with a clinically useful negative likelihood ratio. In subgroup analysis, synovial PMN %, synovial fluid culture, serum ESR, and serum CRP had limited utility for detecting persistent infection before reimplantation (positive likelihood ratios ranging 2.33-3.74; negative likelihood ratios ranging 0.31-0.9) and no utility for predicting failure after the second stage of 2-stage revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Synovial WBC count, synovial PMN %, synovial fluid culture, serum ESR, and serum CRP have modest sensitivity and specificity for predicting persistent infection during the second stage of 2-stage revision, suggesting some combination of these diagnostic tests might be useful before reimplantation. No biomarker or culture accurately predicted treatment failure after reimplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\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.rvw.22.00201","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T15:05:53Z","timestamp":1679497553000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":17,"title":["Utility of Diagnostic Tests Before Reimplantation in Patients Undergoing 2-Stage Revision Total Joint Arthroplasty"],"prefix":"10.2106","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8845-5645","authenticated-orcid":false,"given":"Irfan A.","family":"Khan","sequence":"first","affiliation":[{"name":"Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-1790","authenticated-orcid":false,"given":"Brandon O.","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2040-8188","authenticated-orcid":false,"given":"Antonia F.","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6302-9471","authenticated-orcid":false,"given":"Nicol\u00e1s","family":"Cort\u00e9s-Penfield","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3545-2333","authenticated-orcid":false,"given":"Thomas G.","family":"Myers","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5404-0433","authenticated-orcid":false,"given":"Timothy S.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Houston Methodist Orthopaedics & Sports Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7434-6897","authenticated-orcid":false,"given":"Gina A.","family":"Suh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9592-1133","authenticated-orcid":false,"given":"Gerald","family":"McGwin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1945-8885","authenticated-orcid":false,"given":"Elie S.","family":"Ghanem","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6626-9913","authenticated-orcid":false,"given":"Yale A.","family":"Fillingham","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,3]]},"reference":[{"issue":"5","key":"r1-20240731","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1016\/j.arth.2020.12.005","article-title":"Projected economic burden of periprosthetic joint infection of the hip and knee in the United States","volume":"36","author":"Premkumar","year":"2021","journal-title":"The J Arthroplasty"},{"issue":"6","key":"r2-20240731","doi-asserted-by":"crossref","first-page":"S327","DOI":"10.1016\/j.arth.2022.01.029","article-title":"Long term results of two-stage revision for chronic periprosthetic knee infection: a multicenter study","volume":"37","author":"Kildow","year":"2022","journal-title":"J Arthroplasty"},{"issue":"6","key":"r3-20240731","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.3390\/jcm11061657","article-title":"Long term results of two-stage revision for chronic periprosthetic hip infection: a multicenter study","volume":"11","author":"Kildow","year":"2022","journal-title":"JCM"},{"key":"r4-20240731","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.artd.2021.05.019","article-title":"Infection and mechanical complications are risk factors for new diagnosis of a mental health disorder after total joint arthroplasty","volume":"10","author":"Figoni","year":"2021","journal-title":"Arthroplasty Today"},{"issue":"2","key":"r5-20240731","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1007\/s11999-012-2595-x","article-title":"Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality","volume":"471","author":"Berend","year":"2013","journal-title":"Clin Orthop Relat Res"},{"issue":"8","key":"r6-20240731","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1302\/0301-620X.103B8.BJJ-2021-0224.R1","article-title":"Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection: long-term outcomes of changing clinical practice in a specialist centre","volume":"103-B","author":"Matar","year":"2021","journal-title":"Bone Joint J"},{"issue":"7","key":"r7-20240731","doi-asserted-by":"crossref","first-page":"S674","DOI":"10.1016\/j.arth.2022.03.017","article-title":"Predictors of reinfection in prosthetic joint infections following two-stage reimplantation","volume":"37","author":"Hartman","year":"2022","journal-title":"J Arthroplasty"},{"issue":"8","key":"r8-20240731","doi-asserted-by":"crossref","first-page":"379","DOI":"10.5194\/jbji-6-379-2021","article-title":"Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study","volume":"6","author":"Bourgonjen","year":"2021","journal-title":"J Bone Joint Infect"},{"issue":"12","key":"r9-20240731","doi-asserted-by":"crossref","first-page":"1682","DOI":"10.1302\/0301-620X.102B12.BJJ-2020-0792.R1","article-title":"Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection: insights into non-completed second-stage cases","volume":"102-B","author":"Corona","year":"2020","journal-title":"Bone Joint J"},{"issue":"11","key":"r10-20240731","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New definition for periprosthetic joint infection: from the workgroup of the Musculoskeletal Infection Society","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"r11-20240731","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.arth.2014.03.009","article-title":"Definition of periprosthetic joint infection","volume":"29","author":"Parvizi","year":"2014","journal-title":"J Arthroplasty"},{"issue":"5","key":"r12-20240731","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"},{"key":"r13-20240731","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"issue":"10","key":"r14-20240731","doi-asserted-by":"crossref","first-page":"1972","DOI":"10.1097\/01.blo.0000534680.87622.43","article-title":"What markers best guide the timing of reimplantation in twostage exchange arthroplasty for PJI? A systematic review and meta-analysis","volume":"476","author":"Lee","year":"2018","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"r15-20240731","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1016\/j.otsr.2018.03.017","article-title":"Tests for predicting reimplantation success of two-stage revision for periprosthetic joint infection: a systematic review and meta-analysis","volume":"104","author":"Bian","year":"2018","journal-title":"Orthop Traumatol Surg Res"},{"issue":"8","key":"r16-20240731","doi-asserted-by":"crossref","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med"},{"issue":"1","key":"r18-20240731","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/1471-2288-6-31","article-title":"Meta-DiSc: a software for meta-analysis of test accuracy data","volume":"6","author":"Zamora","year":"2006","journal-title":"BMC Med Res Methodol"},{"issue":"11","key":"r19-20240731","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"issue":"1","key":"r20-20240731","doi-asserted-by":"crossref","first-page":"7323","DOI":"10.1038\/s41598-021-86890-z","article-title":"The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection","volume":"11","author":"Ackmann","year":"2021","journal-title":"Sci Rep"},{"issue":"11","key":"r21-20240731","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1302\/0301-620X.99B11.BJJ-2017-0243-R1","article-title":"A positive bacterial culture during reimplantation is associated with a poor outcome in two-stage exchange arthroplasty for deep infection","volume":"99-B","author":"Akg\u00fcn","year":"2017","journal-title":"Bone Joint J"},{"issue":"9","key":"r22-20240731","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1097\/CORR.0000000000001788","article-title":"Synovial cell count before reimplantation can predict the outcome of patients with periprosthetic knee infections undergoing two-stage exchange","volume":"479","author":"Ascione","year":"2021","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"r23-20240731","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1186\/s12891-016-0991-1","article-title":"Comparison of cultures and 16S rRNA sequencing for identification of bacteria in two-stage revision arthroplasties: preliminary report","volume":"17","author":"Bereza","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"issue":"2","key":"r24-20240731","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.21873\/invivo.12352","article-title":"Synovial alpha-defensin at reimplantation in two-stage revision arthroplasty to rule out persistent infection","volume":"35","author":"Bielefeld","year":"2021","journal-title":"In Vivo"},{"issue":"1","key":"r25-20240731","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13018-017-0703-z","article-title":"Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers","volume":"13","author":"Boelch","year":"2018","journal-title":"J Orthop Surg Res"},{"key":"r26-20240731","doi-asserted-by":"crossref","first-page":"6720712","DOI":"10.1155\/2018\/6720712","article-title":"Synovial fluid aspiration should not Be routinely performed during the two-stage exchange of the knee","volume":"2018","author":"Boelch","year":"2018","journal-title":"Biomed Res Int"},{"issue":"6","key":"r27-20240731","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.2106\/00004623-200706000-00011","article-title":"Usefulness of histological analysis for predicting the presence of microorganisms at the time of reimplantation after hip resection arthroplasty for the treatment of infection","volume":"89","author":"Bori","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"r28-20240731","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1016\/j.arth.2021.02.001","article-title":"What is the clinical utility of synovial alpha defensin testing of antibiotic spacers before reimplantation?","volume":"36","author":"Carender","year":"2021","journal-title":"J Arthroplasty"},{"issue":"2","key":"r29-20240731","doi-asserted-by":"crossref","first-page":"82","DOI":"10.5792\/ksrr.2015.27.2.82","article-title":"Two-stage total knee arthroplasty for prosthetic joint infection","volume":"27","author":"Cha","year":"2015","journal-title":"Knee Surg Relat Res"},{"issue":"5","key":"r30-20240731","doi-asserted-by":"crossref","first-page":"684","DOI":"10.2106\/00004623-199905000-00009","article-title":"Analysis of frozen sections of intraoperative specimens obtained at the time of reoperation after hip or knee resection arthroplasty for the treatment of infection*","volume":"81","author":"Della Valle","year":"1999","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"r31-20240731","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1186\/s13018-018-0885-z","article-title":"The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors","volume":"13","author":"Fu","year":"2018","journal-title":"J Orthop Surg Res"},{"issue":"7","key":"r32-20240731","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1007\/s11999-015-4673-3","article-title":"Are frozen sections and MSIS criteria reliable at the time of reimplantation of two-stage revision arthroplasty?","volume":"474","author":"George","year":"2016","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"r33-20240731","doi-asserted-by":"crossref","first-page":"S205","DOI":"10.1016\/j.arth.2017.12.018","article-title":"Utility of serological markers for detecting persistent infection in two-stage revision arthroplasty in patients with inflammatory arthritis","volume":"33","author":"George","year":"2018","journal-title":"J Arthroplasty"},{"issue":"7","key":"r34-20240731","doi-asserted-by":"crossref","first-page":"1699","DOI":"10.1007\/s11999-009-0742-9","article-title":"Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation?","volume":"467","author":"Ghanem","year":"2009","journal-title":"Clin Orthop Relat Res"},{"issue":"8","key":"r35-20240731","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1302\/0301-620X.88B8.17445","article-title":"Two-stage revision of infected total knee replacements using articulating cement spacers and short-term antibiotic therapy","volume":"88-B","author":"Hart","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"1","key":"r36-20240731","doi-asserted-by":"crossref","first-page":"34","DOI":"10.3928\/01477447-20190103-03","article-title":"Classic markers for infection perform poorly in predicting residual infection prior to reimplantation","volume":"42","author":"Herman","year":"2019","journal-title":"Orthopedics"},{"issue":"1","key":"r37-20240731","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1302\/0301-620X.97B1.33802","article-title":"Interleukin-6 in two-stage revision arthroplasty: what is the threshold value to exclude persistent infection before re-implantation?","volume":"97-B","author":"Hoell","year":"2015","journal-title":"Bone Joint J"},{"issue":"4","key":"r38-20240731","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s00402-015-2404-6","article-title":"Two-stage revision arthroplasty for periprosthetic joint infections: what is the value of cultures and white cell count in synovial fluid and CRP in serum before second stage reimplantation?","volume":"136","author":"Hoell","year":"2016","journal-title":"Arch Orthop Trauma Surg"},{"issue":"6","key":"r39-20240731","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1016\/j.arth.2017.01.031","article-title":"Leukocyte esterase strip test can predict subsequent failure following reimplantation in patients with periprosthetic joint infection","volume":"32","author":"Kheir","year":"2017","journal-title":"J Arthroplasty"},{"issue":"4","key":"r40-20240731","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1007\/s11999-010-1619-7","article-title":"What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee?","volume":"469","author":"Kusuma","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"r41-20240731","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/s13018-021-02477-4","article-title":"The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study","volume":"16","author":"Li","year":"2021","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"r42-20240731","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.artd.2016.08.002","article-title":"ESR and CRP are useful between stages of 2-stage revision for periprosthetic joint infection","volume":"3","author":"Lindsay","year":"2017","journal-title":"Arthroplasty Today"},{"issue":"1","key":"r43-20240731","first-page":"68","article-title":"Identifying ongoing infection after resection arthroplasty and before second-stage reimplantation","volume":"14","author":"Lonner","year":"2001","journal-title":"Am J Knee Surg"},{"issue":"4","key":"r44-20240731","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.21873\/invivo.12518","article-title":"Low diagnostic value of synovial aspiration culture prior to reimplantation in periprosthetic joint infection","volume":"35","author":"Macke","year":"2021","journal-title":"In Vivo"},{"issue":"11","key":"r45-20240731","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.2106\/00004623-200011000-00006","article-title":"Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection: a comparison-group study*","volume":"82","author":"Mont","year":"2000","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"r46-20240731","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1007\/s11999-011-2030-8","article-title":"Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure","volume":"469","author":"Javad Mortazavi","year":"2011","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"r47-20240731","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1007\/s11999-014-3571-4","article-title":"Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections","volume":"472","author":"Nelson","year":"2014","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"r48-20240731","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1007\/s11999-016-5093-8","article-title":"What is the diagnostic accuracy of aspirations performed on hips with antibiotic cement spacers?","volume":"475","author":"Newman","year":"2017","journal-title":"Clin Orthop Relat Res"},{"issue":"7","key":"r49-20240731","doi-asserted-by":"crossref","first-page":"1458","DOI":"10.1097\/CORR.0000000000001738","article-title":"Plasma D-dimer does not anticipate the fate of reimplantation in two-stage exchange arthroplasty for periprosthetic joint infection: a preliminary investigation","volume":"479","author":"Pannu","year":"2021","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"r50-20240731","doi-asserted-by":"crossref","first-page":"231","DOI":"10.3928\/01477447-20170411-04","article-title":"Inadequacy of joint aspiration for detection of persistent periprosthetic infection during two-stage septic revision knee surgery","volume":"40","author":"Preininger","year":"2017","journal-title":"Orthopedics"},{"issue":"6","key":"r51-20240731","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.arth.2013.12.027","article-title":"Two-stage revision for prosthetic joint infection: outcome and role of reimplantation microbiology in 107 cases","volume":"29","author":"Puhto","year":"2014","journal-title":"J Arthroplasty"},{"issue":"5","key":"r52-20240731","doi-asserted-by":"crossref","first-page":"916","DOI":"10.1302\/0301-620X.103B5.BJJ-2020-0703.R3","article-title":"Positive frozen section during reimplantation increases the risk of treatment failure in two-stage exchange arthroplasty even in patients with normal ESR and CRP","volume":"103-B","author":"Qiao","year":"2021","journal-title":"Bone Joint J"},{"issue":"1","key":"r53-20240731","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1186\/s13018-019-1448-7","article-title":"Does serum interleukin-6 guide the diagnosis of persistent infection in two-stage hip revision for periprosthetic joint infection?","volume":"14","author":"Qu","year":"2019","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"r54-20240731","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.aott.2018.02.002","article-title":"Intraoperative evaluation of polymorphonuclear leukocyte during second-stage revision surgery promote overdiagnosis of persistent periprosthetic joint infection","volume":"52","author":"Saitoh","year":"2018","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"7","key":"r55-20240731","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1097\/CORR.0000000000000620","article-title":"Positive alpha-defensin at reimplantation of a two-stage revision arthroplasty is not associated with infection at 1 year","volume":"477","author":"Samuel","year":"2019","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"r56-20240731","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s00264-010-1014-8","article-title":"Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection","volume":"35","author":"Schindler","year":"2011","journal-title":"Int Orthopaedics"},{"issue":"17","key":"r57-20240731","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.2106\/JBJS.16.01395","article-title":"Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation","volume":"99","author":"Shahi","year":"2017","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"r58-20240731","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.arth.2010.05.006","article-title":"Perioperative testing for persistent sepsis following resection arthroplasty of the hip for periprosthetic infection","volume":"25","author":"Shukla","year":"2010","journal-title":"J Arthroplasty"},{"issue":"7","key":"r59-20240731","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.arth.2019.03.019","article-title":"Clinical evaluation of alpha defensin test following staged treatment of prosthetic joint infections","volume":"34","author":"Stone","year":"2019","journal-title":"J Arthroplasty"},{"issue":"2","key":"r60-20240731","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1302\/0301-620X.94B2.27779","article-title":"The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis","volume":"94-B","author":"Sorl\u00ed","year":"2012","journal-title":"J Bone Joint Surg Br"},{"issue":"15","key":"r61-20240731","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.2106\/JBJS.15.01469","article-title":"Positive culture during reimplantation increases the risk of subsequent failure in two-stage exchange arthroplasty","volume":"98","author":"Tan","year":"2016","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"r62-20240731","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1016\/j.arth.2020.05.029","article-title":"Do positive cultures at second stage re-implantation increase the risk for reinfection in two-stage exchange for periprosthetic joint infection?","volume":"35","author":"Theil","year":"2020","journal-title":"J Arthroplasty"},{"issue":"1","key":"r63-20240731","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.knee.2012.06.004","article-title":"Two-stage reimplantation for periprosthetic knee infection: influence of host health status and infecting microorganism","volume":"20","author":"Tigani","year":"2013","journal-title":"Knee"},{"issue":"1","key":"r64-20240731","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1186\/s13018-019-1179-9","article-title":"Plasma fibrinogen may predict persistent infection before reimplantation in two-stage exchange arthroplasty for periprosthetic hip infection","volume":"14","author":"Xu","year":"2019","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"r65-20240731","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s13018-019-1223-9","article-title":"Can we rely on the combination of serological tests and frozen sections at the time of reimplantation for two-stage exchange hip arthroplasty in patients with a \u201cdry tap\u201d?","volume":"14","author":"Xu","year":"2019","journal-title":"J Orthop Surg Res"},{"issue":"9","key":"r66-20240731","doi-asserted-by":"crossref","first-page":"2820","DOI":"10.1016\/j.arth.2017.03.068","article-title":"Utility of synovial white blood cell count and differential before reimplantation surgery","volume":"32","author":"Zmistowski","year":"2017","journal-title":"J Arthroplasty"},{"issue":"6","key":"r67-20240731","doi-asserted-by":"crossref","first-page":"1696","DOI":"10.1016\/j.arth.2020.01.080","article-title":"Is treatment of periprosthetic joint infection improving over time?","volume":"35","author":"Xu","year":"2020","journal-title":"J Arthroplasty"},{"issue":"4","key":"r68-20240731","first-page":"203","article-title":"Measures of diagnostic accuracy: basic definitions","volume":"19","author":"\u0160imundi\u0107","year":"2009","journal-title":"EJIFCC"},{"issue":"7459","key":"r69-20240731","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1136\/bmj.329.7459.209","article-title":"Ruling a diagnosis in or out with \u201cSpPIn\u201d and \u201cSnNOut\u201d: a note of caution","volume":"329","author":"Pewsner","year":"2004","journal-title":"BMJ"},{"issue":"2","key":"r70-20240731","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1097\/01.blo.0000533618.31937.45","article-title":"Does change in ESR and CRP guide the timing of two-stage arthroplasty reimplantation?","volume":"477","author":"Stambough","year":"2019","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"r71-20240731","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1186\/s13018-020-01923-z","article-title":"Changes in serum markers failed to predict persistent infection after two-stage exchange arthroplasty","volume":"15","author":"Jiang","year":"2020","journal-title":"J Orthop Surg Res"},{"issue":"3","key":"r72-20240731","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1007\/s12178-018-9495-y","article-title":"Two-stage revision arthroplasty for the treatment of prosthetic joint infection","volume":"11","author":"Charette","year":"2018","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"3","key":"r73-20240731","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.arth.2019.09.044","article-title":"Treatment outcomes and attrition in gram-negative periprosthetic joint infection","volume":"35","author":"Kalbian","year":"2020","journal-title":"J Arthroplasty"},{"issue":"2 suppl","key":"r74-20240731","first-page":"187","article-title":"Epidemiological and clinical features of prosthetic joint infections caused by gram-negative bacteria","volume":"23","author":"Fantoni","year":"2019","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"24","key":"r75-20240731","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.2106\/JBJS.15.01450","article-title":"Polymicrobial periprosthetic joint infections: outcome of treatment and identification of risk factors","volume":"98","author":"Tan","year":"2016","journal-title":"J Bone Joint Surg Am"},{"key":"r76-20240731","doi-asserted-by":"crossref","DOI":"10.1007\/s00402-021-04330-z","article-title":"Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?","author":"Steinicke","year":"2022","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"r77-20240731","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s12178-018-9504-1","article-title":"Risk factors and treatment options for failure of a two-stage exchange","volume":"11","author":"Fagotti","year":"2018","journal-title":"Curr Rev Musculoskelet Med"},{"issue":"2","key":"r78-20240731","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/rheumatology\/keh021","article-title":"Automated counting of white blood cells in synovial fluid","volume":"43","author":"de Jonge","year":"2003","journal-title":"Rheumatology (Oxford)"}],"container-title":["JBJS Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.22.00201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:36:50Z","timestamp":1787751410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.RVW.22.00201"}},"subtitle":["A Systematic Review and Meta-analysis"],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":77,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.rvw.22.00201","relation":{},"ISSN":["2329-9185"],"issn-type":[{"value":"2329-9185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}