Global biomarker trends in Periprosthetic Joint infection research: a bibliometric analysis

Background Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty associated with high morbidity and costs​. Early and accurate diagnosis is essential, yet no single “gold-standard” test exists​. Traditional methods have limitations in sensitivity and specificity. Biomarkers have therefore gained attention as adjuncts to improve PJI detection. This study uses bibliometric analysis to elucidate global research trends in PJI biomarkers, reflecting the growing need for better diagnostic tools. Methods A comprehensive literature search of the Web of Science Core Collection (2011–2024) was conducted for publications on PJI diagnostics and biomarkers​​. Eligible articles included both research and review papers​. Bibliometric indicators (annual output, citations, h-index), collaboration networks, and keyword co-occurrence were analyzed using VOSviewer, CiteSpace, and Bibliometrix in R​. Co-citation analysis identified influential references, and keyword analysis mapped evolving research hotspots. Recent high-impact studies (2020–2024) and consensus guidelines were reviewed to contextualize bibliometric findings. Results Publications on PJI biomarkers grew exponentially, from < 5 per year before 2014 to 57 in 2020​, indicating surging interest. The 380 documents accrued over 5,000 citations, with an average of 13.8 citations per paper. China (103) and the USA (88) contributed half of all outputs, with the USA having the highest citation impact; Germany, the UK, and Italy also featured prominently. Collaborative network analysis identified Parvizi J. , Trampuz A. , and the Rothman Institute as central nodes. The Journal of Arthroplasty accounted for 12.6% of publications, while The Journal of Bone and Joint Surgery American Volume and Clinical Orthopaedics and Related Research achieved the highest citations per article. Keyword analysis revealed “α-defensin,” “C-reactive protein,” and “diagnosis” as common themes, with research evolving from conventional serologic markers (2011–2015) to synovial α-defensin and leukocyte esterase assays (2016–2018), and more recently to synovial calprotectin, machine learning, microfluidics, and molecular diagnostics (2019–2024). Conclusion Between 2011 and 2024, research on PJI biomarkers expanded significantly, led by institutions in the US, China, and Europe. Synovial α-defensin, calprotectin, machine learning, and next-generation sequencing emerged as key themes. Future efforts must prioritize global multicenter validation, assay standardization, and integrated diagnostic models. Strengthened interdisciplinary collaboration, comprehensive data sharing, and advanced decision-support tools will drive earlier detection and timely, personalized management of PJI. These strategies promise to improve patient outcomes worldwide.