This retrospective study analyzed 682 patients who underwent primary total hip or knee arthroplasty to evaluate the impact of malnutrition on post-operative outcomes. Malnutrition, as defined by the Nutritional Risk Screening 2002 (NRS-2002) and controlling nutritional status (CONUT) scores, was significantly associated with higher rates of post-operative infection and poorer quality-of-life scores. Early nutritional assessment may improve post-operative recovery and reduce complication rates.

This study examined thousands of joint fluid samples to understand which bacteria cause infections in natural and artificial joints. Staphylococci were the main culprits, and antibiotic resistance increased over time, especially in methicillin-resistant and beta-lactamase-producing strains. Testing joint fluids in blood culture bottles improved detection, helping doctors to choose more effective treatments and protect joint health.

Founded in 2019, the Center for Musculoskeletal Infections at University Hospital Basel was established to implement standardized, multidisciplinary care for orthopaedic and trauma-related infections. This retrospective analysis of hip and knee periprosthetic joint infections (2019–2022) illustrates the feasibility and effectiveness of this structured approach, with infection control achieved in the majority of patients despite case complexity.

Periprosthetic joint infection (PJI) patient care has both positive and negative impacts on caregivers: (1) conflicts regarding the hospital stay, (2) novel personal challenges, (3) nursing, (4) emotional and psychological consequences, and (5) effects on the relationship. To conclude, caregivers of PJI patients shoulder a relevant burden both physically and emotionally, which seems to be very similar to caregivers of cancer patients. An inclusion in established treatment algorithms for PJI should be considered.

Although local antibiotic administration is used to prevent and treat fracture-related infections, concerns remain about systemic absorption and potential renal toxicity. This study assessed serum levels and renal function after local gentamicin or vancomycin use. Gentamicin exceeded the lower limit of quantification in 17% of cases but remained below toxic levels. Vancomycin was undetectable. These findings suggest that local antibiotic administration does not harm renal function.

Pseudomonas aeruginosa is a common pathogen in Gram-negative periprosthetic joint infections (PJIs). It is resistant to many antibiotics and forms biofilm, making it difficult to treat. We analyzed 1286 patients who underwent 1640 surgeries; among them, 38 patients with 50 procedures had P. aeruginosa. Most infections were chronic, often in hip revisions, with a high failure rate and recurrence. Due to its clinical and microbiological features, P. aeruginosa-related PJIs remain challenging.

In Lyme-endemic regions, Lyme disease should be considered in culture-negative periprosthetic joint infection (PJI). Diagnosis relies on microbial DNA detection, particularly Borrelia-targeted polymerase chain reaction (PCR) on synovial fluid or tissue. We present 10 cases highlighting the value of PCR for early recognition of this pathogen, which is not detectable by conventional culture media. Surgical debridement remains the standard of care, though several cases were successfully treated medically, an observation that merits further investigation.

In this study, we tested whether very high doses and prolonged exposure of gentamicin, alone or with rifampin, can eliminate mature Staphylococcus aureus biofilm – one of the main causes of implant-associated infections. None of the regimes tested eradicated all bacteria. Adding rifampin gave no benefit. This suggests that aminoglycosides are not optimal for local antibiotic therapy.

This study assessed whether the diagnosis and management of fracture-related infections (FRIs) in a low- and middle-income countries (LMICs) currently align with consensus guidelines. We found that two-thirds of cases are managed outside the international guidelines. While the consensus definition is applicable, diagnostic capacity remains limited and microbiological standards are often impractical. Our findings highlight the need to adapt guidelines to local realities and to strengthen capacity in LMICs.

Several factors have been linked to failure in chronic prosthetic joint infection revisions. We hypothesize that osteomyelitis in septic hip revisions is underestimated and may significantly impact outcomes. In this series, 30.8 % of septic revisions exhibited bone samples consistent with osteitis, mainly associated with prolonged unsuccessful surgical and antibiotic treatments, the presence of a sinus tract, and subsequent failure after implant removal.

Fungal organisms are conventionally estimated to account for 1 % –2 % of periprosthetic joint infection (PJI) cases, although diagnostic and reporting limitations may result in systematic underestimation. Using a quantitative missing-data sensitivity analysis across 23 studies encompassing 28 253 PJI cases, we estimated an adjusted Candida PJI proportion of approximately 5 %, increasing to nearly 10 % in chronic or refractory infections.

Infections represent a serious complication following the implantation of osteoarticular devices. Rifampicin in combination with fluoroquinolone is the most prescribed antibiotic regimen. Nevertheless, fluoroquinolones are associated with significant adverse effects. We sought to evaluate whether oral tetracyclines could serve as an alternative therapeutic option. Our findings suggest that tetracyclines may constitute a suitable alternative in cases where fluoroquinolones are not usable.

A simple, rapid, and low-cost test measuring synovial fluid specific gravity shows high accuracy and excellent specificity for diagnosing hip and knee periprosthetic joint infection. This method can quickly help rule in infections during revision surgeries, making it a practical point-of-care tool, especially in clinics or hospitals with limited resources. Its performance supports use alongside established lab markers for better patient outcomes.

Staphylococcus aureus bloodstream infection can cause serious complications such as bone and joint involvement. We reviewed 489 cases (2017–2022) at a Brussels tertiary hospital to identify risk factors. Prolonged bacteremia and community acquisition increased the risk, while active cancer and intensive-care stay reduced it. This study highlights the burden of bone and joint infections in Staphylococcus aureus bloodstream infection.

This is a case report which follows a patient who received multiple false positive synovial alpha-defensin test results following a revision for total knee arthroplasty. The report looks at the importance of generalizability in diagnostic testing and how a lack thereof can extend the cost and duration of care.

We studied whether placing vancomycin powder directly into the wound during orthopedic surgery harms the kidneys. In 50 patients, kidney function before and after surgery stayed essentially stable, even with higher doses. Our findings suggest that this local antibiotic strategy is unlikely to cause short-term kidney damage.

We developed a pig model to study how different tissue flaps support the healing microenvironment of lower-leg composite defects. By measuring tissue metabolism and examining tissue samples under the microscope, we found distinct early responses between muscle and fascia-based flaps. This model may help researchers and clinicians better understand the healing of complex bone and soft-tissue defects and may provide a platform for evaluating clinically relevant ortho-plastic outcomes.

We have developed and evaluated an anodized stainless-steel surface treatment that significantly reduced bacterial adherence and biofilm formation by pathogens linked to orthopedic implant infections. Using laboratory conditions that mimic the human joint environment, our findings suggest that this surface treatment could enhance implant safety by preventing infection-related complications.

Pubic bone osteomyelitis (PBO) is a rare complication with sometimes delayed development in patients who have received radiotherapy or surgery of the pelvic region for cancer treatment. In this single-center case series of patients with cancer, we sought to characterize outcomes of PBO. We conducted a retrospective analysis of 26 patients and found that a combination of surgical debridement plus targeted antibiotic therapy offered the best outcomes. 

This study explored whether blue light could help treat difficult joint implant infections caused by drug-resistant bacteria. A new optical fiber that delivers light evenly was tested in the lab. Blue light reduced bacteria more with higher power and longer exposure. These findings suggest that this fiber could support future light-based treatments for deep surgical infections.

A multi-center study of 563 periprosthetic joint infections (PJIs) found that 16.5 % were culture negative. These patients more often had prior revision or PJI, longer symptom duration and fewer systemic signs. On multivariable analysis, symptom duration >12 weeks was the only independent risk factor (odds ratio 2.24). The findings support the fact that culture-negative infections present insidiously, informing diagnostic strategies.

 

Patients who undergo repeat surgery due to joint infection after a hip or knee replacement have a higher risk of dying compared with those who have revision surgery for other reasons. We studied more than 9000 patients using national health data to explore why this happens. We found that the higher risk cannot be explained by a single cause of death but is linked to many common health problems. This suggests that these patients are especially vulnerable and may need broader medical support.

A total of 51 studies were reviewed to compare the alpha-defensin enzyme-linked immunosorbent assay (ELISA) and the lateral flow test for diagnosing joint replacement infections. Both tests are highly specific and accurately confirm infection, but ELISA showed greater sensitivity (87.8 % vs. 81.8 %), making it better for detection. These findings support the continued use of ELISA as the preferred diagnostic method.

This study evaluated the effectiveness of systemic antibiotic therapy against S. aureus and P. aeruginosa biofilm-associated infections in a large animal (ovine) model of fracture-related infection (FRI). Systemic therapy reduced some bacterial load, but most samples did not significantly differ from positive controls. Histological findings corroborated persistent infection. These results validate the model and underscore the limitations of systemic therapy in effectively managing FRI.

This study performed an external validation of the so-called JS-BACH classification from 2021, which aims to help predict the outcome of periprosthetic joint infections using three groups of increasing severity. Using data from 249 patients, we found that higher severity scores were strongly linked to an increased failure rate. This simple tool could guide doctors in tailoring treatments and improving results for patients with these challenging infections.

Isolation of patients with musculoskeletal infections in orthopedic care is controversial. Evidence supports selective isolation for certain resistant pathogens but not for non-resistant pathogens, nor does it support the routine use of septic wards. Effective infection control depends on hospital-wide strategies and adherence to standard precautions, with specialized centres offering better care than dedicated isolation units.

This single-center retrospective study focused on the utility of modular megaprostheses in patients with chronic hip or knee periprosthetic joint infections. Among the 61 included patients, 37.7 % experienced any type of failure, with infection recurrence being the most common reason. While infection control was acceptable, the rates of any-type failure were high. Moreover, patients classified as McPherson host grade C, representing compromised hosts, are at greater risk of experiencing failure.