Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma

İbrahim Halil Demir; Mustafa Onur Karaca; Mustafa Özyıldıran; Onur Kaya; İdris Perktaş; Hüseyin Yusuf Yıldız

doi:10.32322/jhsm.1963531

Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma

Abstract

Aims: Prosthetic joint infection (PJI) is a challenging disease associated with substantial patient disability and high treatment costs. This study aimed to evaluate the association between inflammatory markers measured in pre-biopsy blood samples and PJI in patients with osteosarcoma. Methods: This retrospective study included 48 patients with osteosarcoma who underwent neoadjuvant chemotherapy followed by resection prosthesis at a tertiary care centre between January 2020 and October 2023. PJI was observed in 7 patients (14.6%) during the 12-month follow-up period, and the diagnosis was established in accordance with the 2018 Musculoskeletal Infection Society criteria. Blood samples collected before biopsy were analyzed for a comprehensive set of inflammatory markers, including white blood cell count, erythrocyte sedimentation rate, C-reactive protein, mean platelet volume, red blood cell distribution width, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and pan-immune-inflammation value. Results: PJI occurred in 7 patients (14.6%), while 41 patients (85.4%) did not develop PJI. There were no significant differences between the two groups in terms of age, body-mass index, gender, affected extremity, or prosthesis location (p>0.05). Patients with PJI had significantly higher NLR (3.9±0.8 vs. 2.0±0.7, p<0.001), PLR (227.5±131.7 vs. 150.0±60.1, p=0.024), SII (1172.1±435.2 vs. 561.1±228.1, p<0.001), SIRI (2.2±0.6 vs. 1.3±0.6, p=0.001), and pan-immune-inflammation value (PIV) (923.9±124.0 vs. 424.4±133.3, p<0.001) compared to patients without PJI. In receiver operating characteristic analysis for PIV value, a cutoff of >570.6 was associated with PJI, with a sensitivity of 100% and specificity of 97.6% (AUC 0.979, 95% CI 0.889-0.999; p<0.001). Conclusion: Pre-biopsy blood levels of NLR, PLR, SII, SIRI, and PIV were significantly associated with PJI in patients undergoing limb-sparing resection and prosthetic reconstruction for osteosarcoma; PIV and NLR showed the highest apparent sensitivity and specificity, without a significant difference between them. Given the small number of events, these findings should be considered hypothesis-generating and require validation in larger, prospective, multicentre cohorts before clinical application.

Keywords

References

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Details

Primary Language

English

Subjects

Infectious Diseases, Clinical Oncology, Orthopaedics

Journal Section

Research Article

Authors

İbrahim Halil Demir ^*
0000-0002-7572-7285
Türkiye

Mustafa Onur Karaca
0000-0003-0783-510X
Türkiye

Mustafa Özyıldıran
0000-0002-2187-9267
Türkiye

Onur Kaya
0000-0002-7164-3156
Türkiye

İdris Perktaş
0009-0005-4582-1560
Türkiye

Hüseyin Yusuf Yıldız
0000-0002-7669-6206
Türkiye

Publication Date

September 19, 2026

Submission Date

June 3, 2026

Acceptance Date

July 28, 2026

Published in Issue

Year 2026 Volume: 9 Number: 5

DOI

https://doi.org/10.32322/jhsm.1963531

IZ

https://izlik.org/JA34ZS59XH

Cite

RIS / Bibtex

APA

Demir, İ. H., Karaca, M. O., Özyıldıran, M., Kaya, O., Perktaş, İ., & Yıldız, H. Y. (2026). Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma. Journal of Health Sciences and Medicine, 9(5), 1319-1327. https://doi.org/10.32322/jhsm.1963531

AMA

1.Demir İH, Karaca MO, Özyıldıran M, Kaya O, Perktaş İ, Yıldız HY. Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma. J Health Sci Med / JHSM. 2026;9(5):1319-1327. doi:10.32322/jhsm.1963531

Chicago

Demir, İbrahim Halil, Mustafa Onur Karaca, Mustafa Özyıldıran, Onur Kaya, İdris Perktaş, and Hüseyin Yusuf Yıldız. 2026. “Association of Pre-Biopsy Inflammatory Indices With Prosthetic Joint Infection After Megaprosthetic Reconstruction for Osteosarcoma”. Journal of Health Sciences and Medicine 9 (5): 1319-27. https://doi.org/10.32322/jhsm.1963531.

EndNote

Demir İH, Karaca MO, Özyıldıran M, Kaya O, Perktaş İ, Yıldız HY (September 1, 2026) Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma. Journal of Health Sciences and Medicine 9 5 1319–1327.

IEEE

[1]İ. H. Demir, M. O. Karaca, M. Özyıldıran, O. Kaya, İ. Perktaş, and H. Y. Yıldız, “Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma”, J Health Sci Med / JHSM, vol. 9, no. 5, pp. 1319–1327, Sept. 2026, doi: 10.32322/jhsm.1963531.

ISNAD

Demir, İbrahim Halil - Karaca, Mustafa Onur - Özyıldıran, Mustafa - Kaya, Onur - Perktaş, İdris - Yıldız, Hüseyin Yusuf. “Association of Pre-Biopsy Inflammatory Indices With Prosthetic Joint Infection After Megaprosthetic Reconstruction for Osteosarcoma”. Journal of Health Sciences and Medicine 9/5 (September 1, 2026): 1319-1327. https://doi.org/10.32322/jhsm.1963531.

JAMA

1.Demir İH, Karaca MO, Özyıldıran M, Kaya O, Perktaş İ, Yıldız HY. Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma. J Health Sci Med / JHSM. 2026;9:1319–1327.

MLA

Demir, İbrahim Halil, et al. “Association of Pre-Biopsy Inflammatory Indices With Prosthetic Joint Infection After Megaprosthetic Reconstruction for Osteosarcoma”. Journal of Health Sciences and Medicine, vol. 9, no. 5, Sept. 2026, pp. 1319-27, doi:10.32322/jhsm.1963531.

Vancouver

1.İbrahim Halil Demir, Mustafa Onur Karaca, Mustafa Özyıldıran, Onur Kaya, İdris Perktaş, Hüseyin Yusuf Yıldız. Association of pre-biopsy inflammatory indices with prosthetic joint infection after megaprosthetic reconstruction for osteosarcoma. J Health Sci Med / JHSM. 2026 Sep. 1;9(5):1319-27. doi:10.32322/jhsm.1963531