This paper describes five cases of prosthetic joint infection (PJI) caused by Mycobacterium avium complex (MAC). Infections occurred in both immune competent and immunosuppressed patients. Interestingly, using the Musculoskeletal Infection Society diagnostic criteria for PJI may miss some cases of MAC PJI. Treatment courses and outcomes are described.

Patients who receive joint replacement surgery might suffer from infection, which usually requires another surgery to clean the prosthesis and remove infected tissue. This tissue is analysed for bacteria in order to start appropriate antibiotic therapy. Bacteria are not always found, calling the appropriateness of the second surgery into question. We compared the treatment outcome in a large group of culture-positive and culture-negative patients and noticed a better outcome in the latter group.

The stoma for transcutaneous osseointegration carries a permanent source of bacterial ingress and infection. The value and role of intraoperative cultures to detect latent bacterial contamination or infection with targeted postoperative antibiotics has not been previously investigated. We compared two cohorts, 8 patients with unexpected positive cultures and 22 patients with negative intraoperative cultures, and found positive cultures do not appear to portend future infectious events.

Bone infection (osteomyelitis) due to Mycobacterium fortuitum, a human pathogen commonly found in soil and water, is a rare disease. Treatment includes antibiotics and surgical removal of infected bone, leaving a bony defect that must be repaired to prevent reinfection and the risk of fracture. Here, M. fortuitum osteomyelitis of the cuboid bone was treated with synthetic antibiotic-loaded cement, successfully resolving inflammation and bone defect filling as well as promoting bone regeneration.

Orthopedic infections are complex, often requiring surgical intervention and prolonged antibiotic therapy, especially in the presence of a foreign body. In a rabbit model of implant-associated methicillin-resistant Staphylococcus aureus osteomyelitis, the lysins exebacase and CF-296 delivered locally with and without systemic daptomycin resulted in lower bacterial counts than those of control animals, showing a promising complement to conventional antibiotics in implant-associated infections.

This paper displays the microbiological differences between infected endoprostheses post tumour resection and infected primary knee arthroplasty. It emphasises the point that significant differences between the two groups, including higher rates of multidrug resistant organisms in the endoprosthetic group, point to the requirement for the pre-emptive use of broad-spectrum empirical antibiotics. Pre-surgical sampling or aspiration is also of particular importance in the endoprosthetic group.

Forty years ago I made a radical professional choice: to dedicate a few years of practice to the African continent. Not surprisingly, a few years became many. This paper is dedicated to the children who are battling osteoarticular infections and to those who will be struggling with them in future.