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Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.

This retrospective case-matched study evaluated males and females with staphylococcal PJI (periprosthetic joint infection) treated with two-stage exchange arthroplasty. We matched 156 males and females for age, type of staphylococcal infection, and joint involved. We compared clinical parameters related to presentation, treatment, and outcome. We did not find a statistically significant difference in outcome between males and females treated with the same surgical approach at our institution.

In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.

The relation between postoperative wound leakage and occurrence of a prosthetic joint infection (PJI) after arthroplasty has not been investigated in a prospective study. We performed a large cohort study in which 1019 patients, after arthroplasty, recorded their wound drainage status in a wound care app during 30 postoperative days. Risk factors for wound drainage were identified. Moderate to heavy wound leakage in the third postoperative week was strongly associated with the occurrence of PJI.

Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.

The antibiotic bead pouch is a useful technique for temporary soft tissue coverage. After the introduction of negative wound pressure therapy, it has fallen into oblivion. However, the technique has several advantages, which are highlighted in the present review article. After debridement, the antibiotic beads deliver high dosages of antibiotics suitable for bone cements. This enables a sterile wound, which might help to avoid either infection or progress of infection.

This systematic review presents the results regarding the concordance rate between preoperative synovial fluid and intraoperative tissue culturing in patients with a prosthetic joint infection (PJI). The included studies had heterogeneous results and were at a high risk of bias. Higher-quality future research may help to better understand the true concordance between these cultures. This may result in better guidance for orthopedic surgeons regarding the treatment of patients with PJI.

While there is no gold standard test to diagnose periprosthetic joint infection (PJI), we believe synovial fluid analysis, especially preoperatively, is a critical step in differentiating between infection and aseptic failure. Adding simple and inexpensive biomarkers such as synovial C-reactive protein (CRP) or adenosine deaminase (ADA) and combined interpretation can be helpful in the context of inconclusive results.

Sometimes after surgery to repair an injured bone or joint, infection can cause the bone to heal improperly. Surgeons use calcium sulfate to prevent infections in joints after surgery. Calcium sulfate can be impregnated with antibiotics and placed inside the joint, where the bloodstream often cannot deliver intravenous or oral antibiotics effectively. We reviewed 20 years of studies of the effectiveness of calcium sulfate and found high rates of healing and infection eradication.

Physicians have difficulties interpreting the isolation of Cutibacterium acnes in the spine tissue. Here we provide the experience of our center about this topic, adding data that can help physicians in their choices. Our results show that some clinical, radiological, and microbiological features can help distinguish patients to treat or not to treat. Moreover, treatment with parenteral beta-lactams appears to be effective, but targeted oral therapy could be a valid alternative.

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.

Pan-spine MRI is warranted in patients who require operative treatment for pyogenic spinal infection to evaluate for multifocal infection.

Despite the success of total hip replacements, there is still a devastating complication that orthopedic surgeons must deal with: periprosthetic infection. We conducted a retrospective study on patients diagnosed with chronic periprosthetic hip infection treated with a two-stage revision using a gentamicin-impregnated articulating cement spacer. We observed a had a high overall success rate (above 90%) and that there were no significant differences between mono- and polymicrobial infections.

We present the first published case of bilateral extensor tenosynovitis caused by Coxiella burnetii. C. burnetii should be considered in patients with inflammatory osteoarticular disease, including tenosynovitis, when conventional cultures are negative especially in elderly, male, or immunocompromised patients with exposure to animals.

Currently, there is no method available to reload antibiotic carriers to treat late bone infections or to prevent bacterial attachment. We propose a novel method to load and protect a biphasic calcium sulfate/hydroxyapatite (CaS/HA) carrier material from bacterial re-population by systemically administering a clinical dose of HA-seeking antibiotic rifampicin (RIF). CaS/HA-based carriers could recruit HA-seeking RIF to locally exert an adequate antibacterial effect at the targeted tissue.

Bone infections are challenging to treat and require new treatments. The current animal models for testing new therapies can be expensive and complex; therefore, we developed a cheap and reliable bone infection model in mice. Our new model features an infected hole created by a needle in the leg bone with a metal pin. This method achieved a consistent infection rate and demonstrates the importance of bacterial biofilm in bone infection.

Tuberculosis is a serious public health problem. A retrospective study of a series of cases of patients with a diagnosis of osteoarticular tuberculosis was carried out from 2014 to 2019. A total of 30 patients were confirmed. The presence of sequelae was correlated with the presence of motor deficit at the beginning of treatment and the high value of C-reactive protein at the end of treatment. These results may contribute to a better understanding of this disease to reduce complications.

Upper extremity abscesses frequently present to the acute care setting with inconclusive physical examination and imaging findings. This study sought to evaluate the diagnostic accuracy of various serum inflammatory markers that are commonly used in the diagnosis of other types of infections. Results demonstrated that C-reactive-protein, an acute phase inflammatory marker, is the most sensitive test, but it is the least specific.

The scientific publication score (SPS) summarizes specific publication results. It is organized into five levels (1–5) based on evidence, data and statistical criteria. In risk factors for prosthetic joint infections, the highest scores were noted for anemia, malignancy and previous alloarthroplasty; for diagnosis methods, these were obtained for aspirate leucocyte count, neutrophils over 80 and interleukin-6 level. SPS is a promising new tool for automatic data mining and systematic reviews.

In a low-resource setting, we studied the risk factors for infection in 101 open fractures treated with the SIGN nail. We found that infection of fractures increased with fracture severity. The treatment-related factors found to have significant association with infection were also essentially the same as those known in advanced countries. We believe low-resource settings could affordably adopt management approaches of high-income countries to achieve good outcomes despite the scarce resources.

This study investigates the ability of a promising new antibiotic, dalbavancin, to be used as an antibiotic incorporated into polymethyl methacrylate (PMMA) cement or other carriers (such as calcium sulfate) to treat bone and joint infections. For antibiotics to be used locally, they must retain their efficacy after heat exposure during PMMA polymerization and at human core body temperature. This study demonstrates that dalbavancin is stable at the temperatures required for local use.

Cancerous transformation is a rare but potentially life-threatening complication of chronic bone infection. As with all forms of cancer, early detection and diagnosis is crucial to outcome.

Whilst there have been over 100 cases of chronic bone infection with cancerous transformation reported in the literature between 1999 and 2020, this is the first case report to document transformation with 20 years of concordant imaging and clinical review.

Magnetic resonance imaging (MRI) is an imaging test that is often used in patients with a suspected bone infection in their foot. MRI findings may impact how these patients are treated; thus, it is important to understand the significance of various MRI findings. This study compared different patterns of MRI findings in these patients to their clinical outcomes. Patients with classic features of bone infection on MRI had the worst outcomes, whereas patients without them sometimes healed.

Tuberculosis (TB) primarily involves the lungs, but it may spread to other sites including joints. TB arthritis, is relatively rare, but it can result in severe damage to the joint and, ultimately, significant functional impairment. This article reviews the current literature on the topic and identifies key areas where further scientific research is needed to improve the diagnosis and management of the disease.

Our study showed that ultrasound-guided aspiration of a total hip arthroplasty was more commonly successful and resulted in fewer dry aspirations than fluoroscopy. Ultrasound-guided aspiration yielded a larger volume of fluid than fluoroscopy, even when excluding dry aspirations. Ultrasound was more sensitive than fluoroscopy in diagnosing prosthetic joint infection (PJI) using culture results only and 2018 Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) criteria.

Patients undergoing multiple hip and knee revision arthroplasty procedures for periprosthetic joint infection can have a changing microbiological picture, which can impact their management and outcomes. We aimed to investigate this using data from two large-volume orthopaedic centres. A total of 106 patients were identified; after six revision procedures, 90 % of patients had different organisms cultured compared with the initial revision and 53 % of the organisms were multidrug resistant.

We compared prosthetic joint infection (PJI) and acute kidney injury (AKI) rates among cohorts before and after changing our hospital's antimicrobial prophylaxis from cefuroxime to teicoplanin plus gentamicin for primary total joint arthroplasty. Switching to teicoplanin and gentamicin was associated with a significant risk reduction for PJI of 75.2 %. Significantly higher AKI rates were seen in patients receiving teicoplanin plus gentamicin; however, these were mild (KDIGO stage 1).

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.