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Periprosthetic Joint Infection (PJI)ARKO-PJINCT07358455

Preop Biomarkers as Outcome Predictors in 2 Stage Revision Surgery for PJI

An observational study of Periprosthetic Joint Infection (PJI), run by Fondazione Policlinico Universitario Agostino Gemelli IRCCS.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Official record
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Trial summary

With the progressive ageing of the population, a significant increase in the incidence of skeletal fractures-particularly of the proximal femur-as well as degenerative conditions such as osteoarthritis has been observed, for which joint arthroplasty represents the treatment of choice. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Periprosthetic Joint Infection (PJI)
How many people
200 participants
Where
No sites listed yet
Study dates
Jan 2026to Dec 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Patients with PJI

Who may be able to join

  • Age ≥ 18 years
  • Diagnosis of an orthopaedic periprosthetic joint infection (PJI)
  • Surgical treatment
  • Minimum follow-up of 12 months
  • Written informed consent to participate in the study

Who cannot join

  • Age < 18 years
  • Patients undergoing prosthetic revision without evidence of periprosthetic joint infection
  • Treatment with antibiotic therapy alone (non-surgical management)
  • Follow-up < 12 months
  • Incomplete dataset
  • Lack of informed consent to participate in the study

About this study

Official title: Identification of Pre-prosthetic Revision Markers Predictive of Outcome in Patients With Periprosthetic Infection

With the progressive ageing of the population, a significant increase in the incidence of skeletal fractures-particularly of the proximal femur-as well as degenerative conditions such as osteoarthritis has been observed, for which joint arthroplasty represents the treatment of choice. However, this procedure is not free from complications; beyond technical and mechanical issues related to potential implant malpositioning, one of the most feared is periprosthetic joint infection (PJI), which poses a major challenge in terms of clinical management and prognostic impact. Therapeutic strategies for PJI range from debridement with retention of the implant and exchange of modular components (DAIR/DAPRI) to complete implant removal with insertion of an articulating spacer, often followed by a subsequent reimplantation procedure. These approaches require prolonged antibiotic regimens, potentially exerting a negative effect on renal function, particularly in cases of extended exposure to nephrotoxic agents. Despite the clinical relevance of this issue, the current literature still provides limited evidence regarding the identification of inexpensive and readily available biomarkers capable of predicting treatment outcomes in PJI, especially in patients undergoing spacer implantation followed by reimplantation. Recent literature has increasingly explored the use of biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), and others to characterize inflammatory and nutritional status, and to investigate possible associations between these markers and the outcomes of selected surgical procedures. The availability of predictive markers could optimize therapeutic management by reducing the risk of infection recurrence and improving postoperative risk stratification.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Biomarkers' capacity to predict the likelihood of prosthetic reimplantation

    The ability of selected preoperative biomarkers (e.g., NLR, PLR) to predict reimplantation outcomes in patients undergoing two-stage revision procedures

    Measured: From enrollment for at least one year

Secondary outcomes (3)

  1. Acute kidney injury

    Incidence of acute kidney injury

    Measured: From enrollment for at least one year

  2. ADL/IADL

    Activities of Daily Living (ADL) assess basic self-care functions (e.g., bathing, dressing, feeding, toileting, transferring), whereas Instrumental Activities of Daily Living (IADL) evaluate more complex skills required for independent living (e.g., managing medications, finances, transportation, shopping, meal preparation)

    Measured: From enrollment for at least one year

  3. SF-12

    The 12-Item Short Form Health Survey (SF-12) is a validated patient-reported outcome measure that provides a concise assessment of health-related quality of life, generating two summary scores: the Physical Component Summary (PCS) and the Mental Component Summary (MCS)

    Measured: From enrollment for at least one year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Jan 2026
  2. Study startJan 2026 (estimated)
  3. Primary completionDec 2026 (estimated)
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Other
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07358455
Sponsor's protocol ID
7818
Acronym
ARKO-PJI
Status last verified
Dec 2025
First submitted
14 Jan 2026
Last updated
23 Jan 2026
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Tarabichi S, Lizcano JD, Abe EA, Goh GS, Baker CM, Parvizi J. Finding the Optimal Screening Test for Periprosthetic Joint Infection: A Prospective Study. J Arthroplasty. 2024 Aug;39(8):1919-1925.e2. doi: 10.1016/j.arth.2024.02.030. Epub 2024 Mar 6.

    PubMed 38452860

  • Jones IA, Wier J, Chen MS, Liu KC, Palmer R, Mayfield CK, Heckmann ND. Complete Blood Count Ratios Predict Adverse Events After Total Joint Arthroplasty. J Am Acad Orthop Surg. 2024 Dec 15;32(24):e1315-e1323. doi: 10.5435/JAAOS-D-24-00184. Epub 2024 Jun 6.

    PubMed 38861722

  • Balato G, Ascione T, Festa E, Di Gennaro D, Pandolfo G, Pagliano P. The Diagnostic Accuracy of Neutrophils to Lymphocytes Ratio, Platelets to Lymphocytes Ratio, Monocytes to Lymphocytes Ratio, and Platelets to Mean Platelet Volume Ratio in Diagnosing Periprosthetic Knee Infections. Are Gender-Specific Cutoff Values Needed? J Arthroplasty. 2023 May;38(5):918-924. doi: 10.1016/j.arth.2022.11.014. Epub 2022 Dec 5.

    PubMed 36481284

  • Ascione T, Balato G, Pagliano P. Upcoming evidence in clinical practice of two-stage revision arthroplasty for prosthetic joint infection. J Orthop Traumatol. 2024 May 18;25(1):26. doi: 10.1186/s10195-024-00767-1.

    PubMed 38761247

  • Zhang QY, Li HX, Xie HQ, Liu LM, Chen L, Zeng Y. Identifying potential predictive indicators for reimplantation timing in two-stage revision: a meta-analysis and system review. Arch Orthop Trauma Surg. 2024 Dec 23;145(1):88. doi: 10.1007/s00402-024-05689-5.

    PubMed 39714508

  • Karlidag T, Zanna L, Mundhe A, Gehrke T, Citak M. Admission Lymphocyte-to-C-Reactive Protein Ratio Predicts 90-Day Adverse Outcomes Following Aseptic Revision Total Hip Arthroplasty. J Arthroplasty. 2026 Aug;41(8):2473-2479. doi: 10.1016/j.arth.2025.11.004. Epub 2025 Nov 7.

    PubMed 41207340

  • Muscaritoli M, Molfino A, Orlando S, Tambaro F. Assessing systemic inflammation and its prognostic value: Glasgow Prognostic Score, neutrophil-to-lymphocyte ratio or other options? Curr Opin Clin Nutr Metab Care. 2025 Sep 1;28(5):367-372. doi: 10.1097/MCO.0000000000001151. Epub 2025 Aug 1.

    PubMed 40772508

  • Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018 May;33(5):1309-1314.e2. doi: 10.1016/j.arth.2018.02.078. Epub 2018 Feb 26.

    PubMed 29551303

  • Mu W, Xu B, Wang F, Guo W, Zhang X, Cao L. Exploring Acute Kidney Injury Incidence in Hip Periprosthetic Joint Infection Treatment With Combined Intravenous and Intra-articular Antibiotic Infusion. Arthroplast Today. 2025 Jan 27;31:101616. doi: 10.1016/j.artd.2025.101616. eCollection 2025 Feb.

    PubMed 39931554

  • Vicenti G, Pesare E, Colasuonno G, Buono C, Albano F, Ladogana T, Passarelli AC, Solarino G. Debridement, Antibiotic Pearls, and Retention of the Implant (DAPRI) in the Treatment of Early Periprosthetic Knee Joint Infections: A Literature Review. Healthcare (Basel). 2024 Apr 16;12(8):843. doi: 10.3390/healthcare12080843.

    PubMed 38667605

  • Perdomo-Lizarraga JC, Combalia A, Fernandez-Valencia JA, Martinez-Pastor JC, Morata L, Soriano A, Munoz-Mahamud E. Long-term implant survival after debridement, antibiotics and implant Retention (DAIR) for acute prosthetic joint infections: is it a viable option beyond four weeks after index arthroplasty? Int Orthop. 2025 Mar;49(3):573-580. doi: 10.1007/s00264-025-06422-6. Epub 2025 Feb 14.

    PubMed 39951052

  • Ayoade F, Li D, Mabrouk A, Todd JR. Periprosthetic Joint Infection. 2023 Oct 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from http://www.ncbi.nlm.nih.gov/books/NBK448131/

    PubMed 28846340

  • Lin S, Villa JM, Rajschmir K, Higuera CA, Grieco P. The Visual Assessment of Cup Position on Anteroposterior Pelvis Radiographs Before Revision Total Hip Arthroplasty for Instability Is Highly Deceiving. Orthopedics. 2025 Jan-Feb;48(1):e22-e26. doi: 10.3928/01477447-20241219-03. Epub 2024 Dec 26.

    PubMed 39724076

  • Li Z. Advancements of biomaterial in hip replacement technology incorporating ceramic materials. J Orthop. 2024 Oct 4;62:27-35. doi: 10.1016/j.jor.2024.09.021. eCollection 2025 Apr.

    PubMed 39473875

  • El Motassime A, Pesare E, Russo A, Salini S, Gava G, Recupero C, Giani T, Covino M, Maccauro G, Vitiello R. The Impact of Frailty and Gender Differences on Hospitalization and Complications in Proximal Femoral Pathological Fractures: A Cross-Sectional Study. J Pers Med. 2024 Sep 18;14(9):991. doi: 10.3390/jpm14090991.

    PubMed 39338245

Questions about this trial

What is this clinical trial studying?

An observational study of Periprosthetic Joint Infection (PJI), run by Fondazione Policlinico Universitario Agostino Gemelli IRCCS.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 23 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Biomarkers' capacity to predict the likelihood of prosthetic reimplantation (time frame: From enrollment for at least one year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07358455, which also lists 16 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Jan 2026.

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