Articles | Volume 10, issue 5
https://doi.org/10.5194/jbji-10-347-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-347-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
01 Oct 2025
Review |
| 01 Oct 2025
| 01 Oct 2025
Single- versus two-stage revision surgery in the case of fracture-related infection: a systematic review
Jonathan Sliepen
Department of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Michelle A. S. Buijs
Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands
Jolien Onsea
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Development and Regeneration, KU Leuven – University of Leuven, Leuven, Belgium
Geertje A. M. Govaert
Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, the Netherlands
Frank F. A. IJpma
Department of Trauma Surgery, University Medical Center Groningen, Groningen, the Netherlands
Jean-Paul P. M. de Vries
Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Bart C. H. Van der Wal
Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
Charalampos Zalavras
Department of Orthopaedic Surgery, Los Angeles General Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
Willem-Jan Metsemakers
CORRESPONDING AUTHOR
Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Development and Regeneration, KU Leuven – University of Leuven, Leuven, Belgium
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Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
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This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Ann-Sophie Jacob, Jolien Onsea, Laura Bessems, Pauline Spoormans, Georges Vles, Willem-Jan Metsemakers, Sien Ombelet, and Melissa Depypere
J. Bone Joint Infect., 10, 317–326, https://doi.org/10.5194/jbji-10-317-2025, https://doi.org/10.5194/jbji-10-317-2025, 2025
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Fracture-related infections (FRIs) and periprosthetic joint infections (PJIs) fail to recover pathogens, posing a diagnostic challenge and impacting treatment. This new method involves homogenising biopsies with beads to release bacteria, followed by inoculation in blood culture bottles using an automated system. This technique shows similar sensitivity to conventional methods, with improved specificity and faster pathogen detection. To date, no other studies have reported an optimized method for incubating biopsies from patients with FRIs.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
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This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
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In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
Baixing Chen, T. Fintan Moriarty, Hans Steenackers, Georges F. Vles, Jolien Onsea, Thijs Vackier, Isabel Spriet, Rob Lavigne, R. Geoff Richards, and Willem-Jan Metsemakers
J. Bone Joint Infect., 9, 249–260, https://doi.org/10.5194/jbji-9-249-2024, https://doi.org/10.5194/jbji-9-249-2024, 2024
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Our research explores natural antimicrobials to combat orthopedic-device-related infections, a challenging issue due to antibiotic resistance. We reviewed agents from bacteria, fungi, viruses, animals, plants and minerals, evaluating their effectiveness and synergy with traditional antibiotics. Our findings suggest these natural alternatives could revolutionize infection management in orthopedic patients, offering new hope for reducing antibiotic resistance and improving treatment outcomes.
Fred Ruythooren, Stijn Ghijselings, Melissa Depypere, Willem-Jan Metsemakers, Liesbet Henckaerts, Nathalie Noppe, and Georges Vles
J. Bone Joint Infect., 9, 167–171, https://doi.org/10.5194/jbji-9-167-2024, https://doi.org/10.5194/jbji-9-167-2024, 2024
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The article examines a unique case of Ureaplasma urealyticum causing osteomyelitis in the greater trochanter of a 26-year-old male treated with ocrelizumab for multiple sclerosis. It emphasizes the necessity of a multidisciplinary approach and advanced PCR diagnostics to manage such rare opportunistic infections effectively, highlighting the challenges faced due to the immunosuppressive nature of monoclonal antibody therapies of this kind.
Jordi Cools, Stijn Ghijselings, Fred Ruythooren, Sander Jentjens, Nathalie Noppe, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 9, 27–35, https://doi.org/10.5194/jbji-9-27-2024, https://doi.org/10.5194/jbji-9-27-2024, 2024
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Septic arthritis (SA) of the native adult hip is a rare orthopaedic emergency. To date, the role of advanced imaging has been confined to supporting or opposing diagnosis; however, implications for surgical decision-making and outcomes have not yet been established. We found that extra-articular abscesses are present in two out of three patients and require varying anatomical approaches. Therefore, we recommend routinely performing advanced imaging in all adults with SA of the native hip joint.
Fred Ruythooren, Stijn Ghijselings, Jordi Cools, Melissa Depypere, Paul De Munter, Willem-Jan Metsemakers, and Georges Vles
J. Bone Joint Infect., 8, 209–218, https://doi.org/10.5194/jbji-8-209-2023, https://doi.org/10.5194/jbji-8-209-2023, 2023
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A total of 41 patients who underwent surgical treatment for septic arthritis (SA) of the native hip were studied. We show that patients with SA of the native hip can be divided in three distinct clinical subgroups based on route of infection. Route of infection is directly related to the chance of femoral head preservation and should, therefore, be the basis for decision-making. Only patients with blood-borne infections in an undamaged hip had a reasonable chance of femoral head preservation.
Niels Vanvelk, Esther M. M. Van Lieshout, Jolien Onsea, Jonathan Sliepen, Geertje Govaert, Frank F. A. IJpma, Melissa Depypere, Jamie Ferguson, Martin McNally, William T. Obremskey, Charalampos Zalavras, Michael H. J. Verhofstad, and Willem-Jan Metsemakers
J. Bone Joint Infect., 8, 133–142, https://doi.org/10.5194/jbji-8-133-2023, https://doi.org/10.5194/jbji-8-133-2023, 2023
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This international retrospective cohort study displays the diagnostic characteristics of 609 patients who were treated for fracture-related infection (FRI). Clinical confirmatory criteria were present in 77% of patients. In the remaining patients, the decision to operatively collect deep tissue cultures had to be based on a set of suggestive criteria. The combined use of these suggestive criteria should guide treating physicians in the management pathway of FRI.
Yorrick P. Bourgonjen, J. Fred F. Hooning van Duyvenbode, Bruce van Dijk, F. Ruben H. A. Nurmohamed, Ewout S. Veltman, H. Charles Vogely, and Bart C. H. van der Wal
J. Bone Joint Infect., 6, 379–387, https://doi.org/10.5194/jbji-6-379-2021, https://doi.org/10.5194/jbji-6-379-2021, 2021
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This study provides a comprehensive overview of a frequently used treatment strategy for chronic prosthetic joint infection of the hip and knee. Forty-seven patients met the inclusion criteria. Successful eradication was achieved in 36 of 47 cases. Multiple variables were analysed to explore their influence on the outcome of two-stage revision surgery. No variables were found to have a significant influence. Mean follow-up of over 10 years provides a good perspective of the long-term outcome.
F. Ruben H. A. Nurmohamed, Bruce van Dijk, Ewout S. Veltman, Marrit Hoekstra, Rob J. Rentenaar, Harrie H. Weinans, H. Charles Vogely, and Bart C. H. van der Wal
J. Bone Joint Infect., 6, 91–97, https://doi.org/10.5194/jbji-6-91-2021, https://doi.org/10.5194/jbji-6-91-2021, 2021
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Literature reporting on the effectiveness of DAIR (debridement, antibiotics and implant retention) procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI-related revision arthroplasty) is scarce. Infection control rates of a DAIR procedure after primary arthroplasty (n = 51) and after prior PJI-related revision arthroplasty (n = 16) were 69 % and 56 %, respectively. No statistically significant difference is found in infection control after 1 year.
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Short summary
This review assessed the effectiveness of single- and two-stage procedures for treating long-bone fracture-related infections, focusing on unhealed fractures without critical-sized bone defects. A total of 35 studies with 985 patients showed bone-healing rates of 80% for single-stage procedures and 77% for two-stage procedures. Infection eradication rates were 87% for single-stage approaches and 81% for two-stage approaches. The current evidence is inconclusive and lacks sufficient data to favor either approach.
This review assessed the effectiveness of single- and two-stage procedures for treating...
