Diagnostic Performance of the Platelet-To-Lymphocyte Ratio (Plr) for Periprosthetic Joint Infection After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis Publisher

Summary: Can a simple blood ratio help spot infected joint implants? A meta-analysis found platelet-to-lymphocyte ratio had moderate accuracy, as an adjunct. #Orthopedics #Diagnostics

Sadeghpour Teymourlou A ; Moradi A ; Akbari Aghdam H ; Yahyazadeh H ; Jafari Zare M A ; Elmi A ; Aslani M R
Source: Knee Surgery and Related Research Published:2026

Abstract

Background: Research has investigated the function of biomarkers, such as the platelet–lymphocyte ratio (PLR), in identifying periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study aimed to conduct an updated systematic review and meta-analysis in order to assess the diagnostic efficacy of PLR for PJI. Methods: Reviews of databases including PubMed, Scopus, and Web of Science were conducted to identify studies related to the use of PLR in diagnosing PJI. The evaluations covered the diagnostic performance of PLR for PJI. Furthermore, because of the significant heterogeneity across the studies, subgroup analyses were conducted focusing on geographic region (China versus other countries), site surgery (unseparated hip and knee versus separated hip and knee), and patient numbers (more than 200 versus less than 200). Results: A total of 4892 TKA and THA patients from 17 studies were included in the meta-analysis. Of the total patients, 1980 (40.5%) were diagnosed with PJI. Diagnostic sensitivity and specificity combined were 0.70 (95% CI 0.62–0.77) and 0.73 (95% CI 0.65–0.79), respectively. Results from the subgroup analysis indicated enhanced sensitivity and specificity concerning geographic differences, surgical site variances, and studies with fewer than 200 patients. Conclusions: PLR demonstrated moderate diagnostic accuracy and could function as an accessible supplementary marker in the evaluation process of PJI; additional research is necessary to establish optimal thresholds and its benefit alongside current diagnostic standards. © The Author(s) 2026.