Predicting periprosthetic joint Infection: Evaluating supervised machine learning models for clinical application

Abstract

Background and objectives

Periprosthetic joint infection (PJI) is a serious complication that can occur after joint arthroplasty, such as hip or knee replacement surgeries. It involves the invasion of the periprosthetic space by pathogens, leading to severe inflammation and often requiring complex medical intervention. PJI is associated with significant morbidity, increased healthcare costs, and a reduced quality of life for patients. This study aims to evaluate the performance of multiple supervised machine learning models in predicting PJI using clinical and demographic data collected from patients who underwent joint arthroplasty.

Methods

Eight supervised machine learning models—Logistic Regression, Random Forest, XGBoost, Artificial Neural Network (ANN), k-Nearest Neighbors (KNN), AdaBoost, Gaussian Naive Bayes (GNB), and Stochastic Gradient Descent (SGD)—were trained and tested on a dataset of 27,854 patients. Models were evaluated using accuracy, precision, recall, specificity, F1 score, and area under the ROC curve (AUC).

Results

Random Forest and XGBoost showed the best overall performance, with high accuracy and balanced metrics across all evaluation criteria. KNN also performed strongly, particularly in minimizing misclassifications. GNB and SGD yielded weaker results, with higher error rates.

Conclusion

Random Forest, XGBoost, and KNN are the most promising models for clinical implementation in PJI prediction. Their robust performance may support earlier diagnosis and improved patient outcomes in orthopedic care.

Translational potential statement

This study demonstrates that machine learning models—particularly Random Forest and XGBoost—can accurately predict periprosthetic joint infection (PJI) using structured electronic health record data. By integrating these models into preoperative assessment workflows, clinicians may be able to identify high-risk patients earlier, personalize prophylactic strategies, and reduce infection-related morbidity. The implementation of these predictive tools has the potential to enhance clinical decision-making, improve surgical outcomes, and optimize the use of healthcare resources in orthopedic practice.