Clinical Signs and Symptoms of Chronic Periprosthetic Joint Infection in the Hip and Knee: A Systematic Review and Meta-Analysis Publisher Pubmed



Hoveidaei AH ; Azimi A ; Alaeddini S ; Budin M ; Tabatabaei FS ; Conway JD ; Gehrke T ; Citak M
Source: Archives of Orthopaedic and Trauma Surgery Published:2026

Abstract

Purpose: the diagnosis of prosthetic joint infection (PJI) as a serious complication after total hip and knee arthroplasty is important; however, current criteria lack a universal definition and often exclude key clinical symptoms. This study evaluates the prevalence of clinical signs and symptoms of chronic hip and knee PJI to provide a descriptive map of clinical presentation. Methods: We conducted a systematic search of Medline, Embase, Web of Science and Scopus to identify studies reporting the prevalence of clinical signs and symptoms in chronic hip or knee PJI published up to June 29, 2024. Statistical analysis was conducted in STATA 17.0 to calculate pooled prevalence and assess heterogeneity. Risk of bias was evaluated using the Joanna Briggs Institute tool. Meta-regression based on the PJI sample size was performed, and a corresponding bubble plot was generated. Results: Of the initial 3,081 records, 2,360 were excluded during title and abstract screening, and 721 articles underwent full-text screening to minimize the exclusion of relevant studies. Ultimately, 26 cohort studies met the inclusion criteria, comprising 2,350 cases. The criteria used to define PJI varied among studies, with the Musculoskeletal Infection Society (MSIS) criteria being the most commonly used. Meta-analysis showed that 38.1% of patients had fever, 24.7% had a fistula or sinus tract, 85.5% reported pain, 62.1% showed local inflammation, and 49.3% had swelling. Subgroup analysis based on the joint and microorganisms involved reduced heterogeneity levels. Conclusion: We concluded that pain, local inflammatory signs, along fever are the most prevalent symptoms of chronic periprosthetic joint infection in the hip and knee. High heterogeneity in several symptoms indicates the pooled prevalence should be interpreted with caution. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.