Articles | Volume 11, issue 4
https://doi.org/10.5194/jbji-11-547-2026
© Author(s) 2026. 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-11-547-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
25 Aug 2026
Original full-length article |
| 25 Aug 2026
| 25 Aug 2026
Periprosthetic fractures around chronically infected total hip arthroplasties: a case series and pragmatic two-stage treatment framework
Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, 3000, Belgium
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Willem-Jan Metsemakers
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Department of Trauma Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Laurens Aerden
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
Department of Trauma Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Jan Geurts
Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, 6229 HX, the Netherlands
Oliver Borens
Department of Orthopaedic Surgery, Clinique Bois Cerf, Hirslanden Group, Lausanne, 1006, Switzerland
Stijn Ghijselings
Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, 3000, Belgium
Institute for Orthopaedic Research and Training (IORT), KU Leuven, Leuven, 3000, Belgium
Department of Development and Regeneration, KU Leuven, Leuven, 3000, Belgium
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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.
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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.
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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.
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Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
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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.
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
Short summary
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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
Short summary
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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
Short summary
Short summary
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
Short summary
Short summary
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.
Tom A. G. Van Vugt, Jeffrey Heidotting, Jacobus J. Arts, Joris J. W. Ploegmakers, Paul C. Jutte, and Jan A. P. Geurts
J. Bone Joint Infect., 6, 413–421, https://doi.org/10.5194/jbji-6-413-2021, https://doi.org/10.5194/jbji-6-413-2021, 2021
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Chronic osteomyelitis is a bone infection and was treated with a combination of antibiotics and two surgeries. With the introduction of the biomaterial S53P4 bioactive glass, these infections can be treated with antibiotics and one surgery. This study shows 85 % success in the treatment of these bone infections. Together with the fundamentally different antibacterial mechanisms without antibiotic resistance, S53P4 bioactive glass is recommendable for the treatment of these infections.
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Short summary
We studied three patients who had both a broken femur and a long-standing infection around an artificial hip, a rare and difficult problem. We treated them in two steps: first removing the implant, cleaning the infection, stabilizing the bone, and placing a temporary bone cement spacer; and then reimplanting the hip prosthesis once infection was controlled. In all cases, the infection cleared, the bone healed, and function improved. This approach may offer a safe way to manage these complex cases.
We studied three patients who had both a broken femur and a long-standing infection around an...
