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.

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. 

Musculoskeletal coccidioidomycosis can present in a variety of ways and often mimics non-infectious disease processes, making timely diagnosis challenging. Missed diagnosis can lead to devastating consequences, including joint destruction. Treatment often involves surgical debridement and prolonged antifungal therapy. Physicians in endemic areas should have a low threshold for obtaining Coccidioides-specific labs when patients present with unexplained musculoskeletal complaints.

Bone and joint infections are common and generally require surgical treatment combined with prolonged antibiotic therapy. It is important to use an antibiotic with good bone penetration that is effective against the commonly encountered pathogens and well-tolerated. Oral tetracyclines are promising and frequently used candidates. This review summarizes the available data on the use of oral tetracyclines in bone and joint infections and highlights the limited data available.

Skin commensal bacteria such as staphylococci are often the source of orthopaedic-device-related infections. Rifampicin is a widely used antibiotic in the treatment of these infections. The results of this study show that oral rifampicin therapy leads to a consistent and persistent induction of resistance in commensal staphylococci on the skin and in the nose for a prolonged time. 

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.

Antibiotics are often used to reduce the rate of recurrent periprosthetic joint infection (PJI) in patients with prior PJI. This study found that patients treated with such prophylactic antibiotics had an increased rate of infection with antibiotic-resistant organisms in any recurrent PJIs that occurred.

Implant-related osteomyelitis is common in orthopedics. Absorbable antibiotic-loaded calcium sulfate (ACS) is an alternative to nonabsorbable antibiotic depot options for osteomyelitis and fracture-related infections. This study aims to evaluate intramedullary canal filling and coating characteristics of ACS around tibial nails using a tibia SAWBONES model. This research was done to better understand the potential utility of ACS in situations requiring fixation in the setting of local infection.

This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.

We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.

Urgent analysis of joint fluid is a common test in patients with possible septic arthritis (bacterial infection of a joint). One aspect of this test, called the Gram stain, is considered important clinically, but previous single hospital studies have suggested it will miss a considerable number of infections. This large multi-hospital UK study assessed this test and found that it will miss 73 % of infections, questioning its value. More research on rapid tests using new technologies is required.

This meta-analysis evaluates synovial fluid white blood cell count and polymorphonuclear neutrophil proportion in order to diagnose chronic peri-prosthetic joint infection. Based on 74 studies, it identifies optimal thresholds, with rule-in and rule-out thresholds enhancing diagnostic precision. Confounding factors such as fractures and inflammatory arthritis are addressed. The findings support standardized diagnostic frameworks in improving accuracy and clinical consistency.

This work outlines the first case study of Candida glabrata bone and joint infection successfully treated with 3 weeks of caspofungin followed by 10 weeks of rezafungin, a new generation of antifungal treatment, using a weekly administration mode. 

When acute soft tissue defects are present after knee arthroplasty, the infection risk is high. A gastrocnemius flap is used for anterior defects, and it is not usually combined with debridement surgery unless infection is clear. We examined the benefit of combining coverage treatment with debridement surgery, DAIR, comparing the isolated traditional coverage treatment. The results suggested a higher healing rate in the combined treatment, so we recommended it.

Our orthopaedic hospital attempts to culture tuberculosis (TB) bacteria from all bone and joint samples sent to the microbiology laboratory. We looked at 6162 TB cultures performed between 2017 and 2022. Bacteria that cause TB, or similar bacteria, were found in 1 in every 229 patients. Tests were more likely to be positive in people being investigated for cancer (sarcoma) and in samples from the spine, whereas they were much less likely to be positive in samples taken from replacement joints.

The desirability of outcome ranking (DOOR) combines joint function, infection cure and mortality into one outcome. Using the DOOR, we describe patient outcomes after prosthetic joint infection (PJI) treatment; moreover, debridement, antibiotics and implant retention (DAIR) is compared with two-stage exchange. Infections were classified as early (≤ 90 d post-arthroplasty) or late (> 90 d post-arthroplasty). For early PJI, DAIR was superior to two-stage exchange, whereas two-stage revision was superior to DAIR for late PJI.

In this article we discuss how gut microbiota can affect the outcomes of a total joint arthroplasty. Total joint arthroplasty is a safe procedure for improving the quality of life in patients affected by arthrosis. Periprosthetic joint infection (PJI) is relatively rare but represents one of the most common causes of implant failure requiring revision surgery. Recently, there has been a major interest in the role of gut microbiome, in particular dysbiosis, as a risk factor for PJI.

A 71-year-old patient underwent shoulder surgery but developed a mild fever, swelling, a burning sensation, and redness of the right shoulder on postoperative day 5. Postoperative septic arthritis was diagnosed, and tissue culture revealed M. catarrhalis. Infection caused by M. catarrhalis is rare after orthopedic surgery, and this is the first reported case of septic arthritis of the glenohumeral joint occurring after arthroscopic surgery. 

This study evaluates dalbavancin, an antibiotic with a long duration of action, in treating complex bone and joint infections. It does not require daily dosing, allowing patients to leave the hospital earlier and reducing costs. Dalbavancin is shown to be effective and safe, especially for patients unsuitable for oral antibiotics or outpatient therapy, achieving similar results to traditional treatments while cutting healthcare costs.

This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.

We present a case of post-traumatic fracture-related infection with the unusual bacteria Metamycoplasma hominis, usually only seen in people with impaired immune systems. Treatment required multiple surgeries, combined with 10 weeks of treatment with the antibiotics doxycycline and clindamycin. There are no guidelines on treatment, but we recommend a multi-disciplinary team approach, with prolonged antibiotic treatment personalised to the patient based on sensitivities of the organism.

Our 10-year multicenter study examines the epidemiology, presentation, management, and outcomes of elbow native joint septic arthritis, a rare condition with risks like reoperation and mortality. Common symptoms included pain and swelling. Synovial fluid white blood cell counts were often low, with monosodium urate crystals also noted. Staphylococcus aureus was the main pathogen, and 72.2 % of patients underwent open debridement.

Our goal was to evaluate the results of two-stage revision of hip periprosthetic joint infection (PJI) over a 20-year period. Our arthroplasty unit is the largest in Ireland. We obtained data for a large number of cases (158 hips) with mid-term to long-term follow-up. Our analysis has found an infection-free survival rate of 84.2 % at 10 years, which was comparable with the best available outcomes. Most of the previously published risk factors were not predictive of failure in our study.

We compared the outcomes of one-stage and two-stage revision surgeries for periprosthetic joint infections of the knee and hip joints. Patients in both groups had similar reinfection rates and functional recovery, but two-stage hip patients experienced more complications, partly due to the temporary use of cement spacers. Our findings suggest that one-stage revision may be a viable alternative to two-stage revision, potentially reducing complications without increasing reinfection risk.

Diabetic foot osteomyelitis is a severe diabetes complication that increases the risk of limb loss and death. This study assessed a one-stage surgical approach with primary wound closure and local antibiotics, showing favourable results. Among 97 patients, 13 needed further treatment, but only 4 required major amputation. Poor circulation was the main factor in failure. These findings challenge traditional methods and may improve quality of life, although further high-quality trials are needed.

We explore optimising antibiotic use to prevent infections in endoprosthetic replacement for bone tumours. We found 26 % of infections were linked to initial surgery, with most due to secondary factors like wound complications. The main bacteria are Staphylococcus aureus and coagulase-negative staphylococci. Our findings suggest targeting these bacteria with prophylactic antibiotics and applying measures to prevent secondary infections to improve infection control in orthopaedic oncology.

This retrospective study shows that autogenous non-vascularized bone graft is a viable option for managing post-osteomyelitis bone defects in children in low-resource settings. Bone union was achieved in all cases at the last follow-up (minimum of 7 years). Recurrence of infection was seen in two cases. Studies into this specific technique are important as it does not require super-specialized centres or skills, both of which are scarce in low-resource settings.

We report the first case of axillary nerve neuropathy in an adult secondary to shoulder septic arthritis with abscess formation. Prompt surgical drainage, lavage, and targeted antibiotic therapy led to full recovery. This case also highlights the risks of intra-articular injections, particularly in immunocompromised patients, and underscores the importance of maintaining a high index of suspicion for septic arthritis in this population, even when the classic signs are absent.

To improve the existing knowledge and treatment of bone and joint infections, it is essential to unite medical disciplines and bridge the gap between basic and clinical sciences. In 2018, the Centrum fOr translational Medicine on Bone and joint INfEctions (COMBINE) was created to facilitate collaboration among Danish scientists and researchers dedicated to bone and joint infection research. This paper aims to share the COMBINE approach and values.

This study explores the effectiveness of repeated debridement, antibiotics, and implant retention (DAIR) for early periprosthetic joint infections (PJIs) after total joint arthroplasty. It shows that repeated DAIR procedures may achieve over 75 % success, which indicates that this approach may have value in managing early PJIs after weighing the benefits and risks of repeated DAIR against implant removal for each patient.