Performance of preoperative inflammatory and immunonutritional indices in predicting periprosthetic joint infection after total knee arthroplasty
Volkan Büyükarslan1
, Aliekber Yapar2, Dilek Yapar3, Erdem Aras Sezgin4
1Department of Orthopedics and Traumatology, Çine State Hospital, Aydın, Türkiye
2Department of Orthopedics and Traumatology, Akdeniz University Faculty of Medicine, Antalya, Türkiye
3Akdeniz University, Institute of Health Science, Medical Informatics, Antalya, Türkiye
4Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Türkiye
Keywords: C-reactive protein-to-albumin ratio, inflammatory biomarkers, periprosthetic joint infection, prognostic nutritional index, risk prediction, total knee arthroplasty.
Abstract
Objectives: This study aims to evaluate the predictive value of preoperative inflammatory and immunonutritional indices for early periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA).
Patients and methods: This study included patients undergoing primary TKA between January 2011 and December 2024 in a retrospective case-control design. Patients who developed PJI within 90 days postoperatively were defined as the infection group (n = 64). A control group (n = 128) was selected using a 1:2 matching ratio based on age, sex, and body mass index (BMI). Preoperative laboratory parameters obtained within 30 days before surgery were used to calculate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), and C-reactive protein-albumin-lymphocyte (CALLY) index. Demographic and clinical variables were recorded. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were performed.
Results: Of the patients, 54 of the patients were male and 138 were females with a mean age of 69.4 ± 8.2 (range, 37 to 86) years. Patients who developed PJI demonstrated significantly lower albumin and lymphocyte levels and higher C-reactive protein (CRP) values. NLR, MLR, SIRI, and CAR were significantly elevated, whereas PNI and CALLY were decreased in the PJI group. The ROC analysis revealed moderate discriminative performance for most biomarkers (area under the curve [AUC] = 0.65-0.71). Multivariate analysis identified low albumin, low PNI, elevated CAR, and general anesthesia as independent predictors of early PJI.
Conclusion: Preoperative inflammatory and immunonutritional indices seem to be associated with early PJI following TKA, with albumin, PNI, and CAR emerging as the most consistent biomarker-based predictors. Although their predictive performance is moderate, these readily available biomarkers may support risk stratification when integrated into comprehensive clinical assessment models.
Citation: Büyükarslan V, Yapar A, Yapar D, Sezgin EA. Performance of preoperative inflammatory and immunonutritional indices in predicting periprosthetic joint infection after total knee arthroplasty. Jt Dis Relat Surg 2027;38(x):i-xi. Doi: 10.52312/ jdrs.2027.2948