Umbrella review maps mortality and failure burden in prosthetic joint infection

An umbrella review published in BMC Musculoskeletal Disorders has mapped the evidence on treatment outcomes and prognostic factors in periprosthetic joint infection (PJI), a serious complication in which infection develops around a hip or knee implant. The review, authored by Jiamin Lu, Kai Zhang and Yongfa Xia, synthesized 53 systematic reviews and meta-analyses identified through a search of the Cochrane Library, Embase, PubMed and Web of Science from inception to April 20, 2026, following PRISMA guidelines. The included analyses reported quantitative outcomes after PJI treatment, and the team assessed methodological quality, risk of bias and certainty of evidence using AMSTAR-2, ROBIS and GRADE respectively.

The headline finding is a substantial descriptive burden of adverse outcomes. Across variable follow-up periods, pooled overall mortality was 11.0% after hip PJI (THA) and 13.3% after knee PJI (TKA). Treatment failure was particularly high for debridement, antibiotics and implant retention (DAIR), with a pooled failure rate of 35.9% that rose to 73.6% in late chronic cases. After one-stage revision, all-cause revision rates were 11.1% for THA and 11.8% for TKA. The authors stress that these pooled burden estimates should be interpreted descriptively, because follow-up durations differed across the source reviews.

Beyond the burden estimates, the review identified several prognostic associations with adverse outcomes. Positive culture at two-stage reimplantation was associated with worse outcomes (OR = 1.92), as were obesity (OR up to 3.63 in TKA) and smoking (RR = 1.84). However, the certainty and replication of these associations varied across the evidence sources, and the overall certainty of the evidence was generally low. The review deliberately stratified evidence signals to separate comparative and prognostic associations from purely descriptive outcome-burden figures.

The authors conclude that PJI carries a substantial burden of mortality and treatment failure, and that available evidence links adverse outcomes to host vulnerabilities, microbiological factors, treatment context and surgical timing. They emphasize that these relationships rest largely on observational evidence rather than demonstrated causal mechanisms. The review’s central recommendation is that future research prioritize standardized outcome definitions and prospective designs to clarify comparative treatment effects and improve individualized risk stratification, addressing the inconsistent terminology and methodological constraints that currently complicate interpretation of prognostic factors and treatment efficacy in this field.

Subject of Research: Treatment outcomes and prognostic factors in periprosthetic joint infection after hip and knee arthroplasty

Article Title: Evidence map for treatment outcomes and prognostic determinants in periprosthetic joint infection: an umbrella review

Article References: Lu, J., Zhang, K., & Xia, Y. (2026). Evidence map for treatment outcomes and prognostic determinants in periprosthetic joint infection: an umbrella review. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-026-10517-5

Image Credits: AI Generated

DOI: 10.1186/s12891-026-10517-5

Keywords: periprosthetic joint infection, umbrella review, hip arthroplasty, knee arthroplasty, DAIR, one-stage revision, two-stage reimplantation, mortality, treatment failure, obesity, smoking, GRADE certainty