Periprosthetic joint infection (PJI) is a severe complication of arthroplasty and causes unrelieved pain and joint dysfunction. Although standardised perioperative management has lowered the risk of hip and knee PJI to less than 2%, PJI is still a significant cause of revision surgery [1][2][3][4][5] . In contrast to aseptic loosening, PJI is often associated with a two-stage revision procedure and long-term antibiotic therapy. Given these adverse implications, an accurate diagnosis method for PJI is valuable in arthroplasty surgery. In the past decades, various diagnostic methods and guidelines have been established for diagnosing PJI. Unfortunately, in the absence of a gold standard test, it is still challenging to differentiate PJI from aseptic loosening 6 . A previous prospective cohort study reported that 25% of PJI patients were misdiagnosed with aseptic loosening in the first year after arthroplasty 7 . Periprosthetic tissue culture and histological examination are reliable diagnostic methods for PJI detection 8 ; however, neither method can guide the operative decision before revision surgery.Inflammatory biomarkers in the serum and synovial fluid can be evaluated before surgery 8 . Traditional biomarkers such as serum white cell count (WCC) and C-reactive protein (CRP) have limited diagnostic accuracy for PJI detection 9,10 . Previous meta-analysis indicated that the sensitivity of serum WCC for PJI detection is 0.45 9 . The pooled sensitivity and specificity of serum CRP are 0.82 and 0.77, respectively 10 . Recently, the diagnostic value of interleukin-6 (IL-6) for PJI detection was investigated. IL-6 is produced by lymphoid and non-lymphoid cells, and it participates in the inflammatory response 11 . Serum IL-6 levels increase with trauma, infection, and surgery [11][12][13] . In patients with aseptic prosthetic loosening, IL-6 levels decrease to the normal level within 48 h after arthroplasty 13 . However, following infection, IL-6 activates the release of CRP 14 . Therefore, the increase of IL-6 precedes that of CRP after infection; thus, IL-6 may be a more sensitive marker for PJI.The previous meta-analysis summarised the results of three studies and showed that high serum IL-6 level strongly indicates PJI 9 . Following this study, the diagnostic capacity of serum and synovial fluid IL-6 for PJI has been widely evaluated; however, there were some discrepancies in the results [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] . The objective of the present meta-analysis was to estimate the value of serum and synovial fluid IL-6 assessments for PJI diagnosis. ResultsSearch Results. A total 323 articles were identified following the database and bibliography search. After further screening, 257 articles were excluded, and 33 articles were excluded after full-text evaluation (Fig. 1).

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