This study explores a solution for patients who suffer a fracture-related infection of the talus following complex ankle injuries. We treated three patients using a two-stage procedure that removes the damaged bone and stabilizes the ankle with a retrograde nail and tantalum spacers. After 3 years, the results showed no relapse of infection, good alignment, and improved quality of life with minimal pain. This approach offers hope for challenging cases where treatment options are limited.

Guidelines currently recommend magnetic resonance imaging as a preferred imaging modality in the diagnosis of diabetic foot osteomyelitis.  We have found that among histologically confirmed cases the positive predictive value of the test is low, questioning its role in disease confirmation.  Additionally, we have found that the majority of cases of diabetic foot osteomyelitis can be successfully treated medically, even amongst histologically confirmed cases. 

We assessed whether two debated scoring tools, KLIC and CRIME-80, could predict the failure of a treatment called debridement, antibiotics, and implant retention (DAIR) in prosthetic joint infections. We reviewed data from 102 patients. Neither score reliably predicted failure, even when the treatment was repeated. Our results highlight the limited clinical utility of these scores and support the need for better tools to guide treatment decisions in joint infections.

The Musculoskeletal Infection Society (MSIS) and the European Bone and Joint Infection Society (EBJIS) are comprised of experts in preventing, diagnosing, and managing orthopedic infections. In 2023, MSIS and EBJIS surveyed their membership about their approach to various clinical aspects of these challenging conditions. The results indicate that, even among experts, there remains substantial variability of practice. This variability reflects open questions in the field. 

We examined whether the way hip replacement is performed affects the types of bacteria that can cause early infection. By reviewing records of 187 patients who needed follow-up surgery due to infection, the researchers found that the surgical technique did not influence which bacteria were present. They also found that body weight had no effect. These results suggest that newer, less invasive surgical methods as the direct anterior approach do not increase infection risks from specific bacteria.

This study provides the largest available, multicenter estimate of chronic osteomyelitis incidence in the United States. Incidence was generally steady over time, although a slight reduction was noted during the COVID-19 pandemic.

Serum C-reactive protein, fibrinogen, and interleukin-6 show the best performance among serum markers for diagnosing periprosthetic joint infection (PJI), but they lack sufficient accuracy to confirm or exclude infection reliably. These markers should be re-evaluated in future PJI definitions, as they are not suitable as stand-alone tests. Given their limitations and the superior diagnostic performance of synovial markers, the role of serum markers in PJI diagnosis should be reconsidered.

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.

Our results indicate that certain parameters such as diabetes, low albumin levels, and prolonged duration of surgery are associated with a higher risk of infection in patients undergoing musculoskeletal tumor resection and megaprosthetic reconstruction. Strategies targeted towards glycemic control and nutritional status optimization are of great significance, while parameters that can affect the operating time can also have a positive impact on periprosthetic joint infection prevention.

Many studies evaluating infection tests after joint replacement focus only on patients who have surgery, but not all painful joints are operated on. This can lead to biased results. Our comment highlights this issue and suggests that including patients who do not have surgery but are monitored over time can give a clearer picture. This helps ensure that infection tests are more accurate when used in everyday medical practice, not just in surgical cases.

In recent decades, there has been a growing emphasis on the use of local antibiotics in orthopaedic surgery, but development of new technologies has been limited. In this study we observe that a 1.5 mL injection of the novel technology CarboCell G/C into the bone provides very high levels of the antibiotics gentamicin and clindamycin in bones, with almost no spill to the bloodstream. These findings bolster the prospect of new and improved technologies for combatting orthopaedic infections.

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.

We performed a mixing lab study describing 20 additional mixing formulas with mixing/set times in creating antimicrobial CaSO₄ beads used for local delivery in periprosthetic joint infections, fracture-related infections, and other bone site infections. Most new formulas were focused on antifungal and antimycobacterial therapy. This information is to be utilized as an open-access reference for all physicians involved in the treatment of musculoskeletal infections.

Arthrofibrosis after total knee arthroplasty (TKA) remains a challenging complication. We analysed 19 TKA cases, isolating low-virulence pathogens in 43 % of them. Although a causal link with low-grade peri-prosthetic joint infection (PJI) is unconfirmed, our findings support its potential role in arthrofibrosis. If validated, this could shift the therapeutic approach toward PJI-oriented management.

Synovial fluid pH, lactate, and glucose levels have been studied in native joint septic arthritis, but their diagnostic value in periprosthetic joint infection (PJI) remains insufficiently explored. This prospective study of 100 patients assessed their utility for PJI diagnosis. PJI cases showed significantly lower synovial pH and glucose levels but higher lactate levels. The combined analysis of all three biomarkers yielded a negative predictive value of 84 % for PJI diagnosis.

Patients with a periprosthetic infection (PJI) have a bad functional outcome and can suffer from a PJI-triggered psychological burden.  Although this has been studied, it is still unclear how to properly screen patients for mental disorders caused by a PJI. Our study showed that the hospital anxiety and depression scale – total (HADS-T) is a valid screening tool for PJI patients and that PJI patients with high HADS-T scores should specifically be offered psychological support.

Proteus is a rare form of bacteria in periprosthetic joint infection (PJI) following knee and hip arthroplasties. In this study, we investigated culture-positive revision surgeries from 2008 until 2024. Proteus species were mainly found in hip arthroplasties. Furthermore, the infections of Proteus species were mainly prevalent in chronic revisions alongside multiple bacteria. Given their chronic and polymicrobial nature, the outcome of Proteus-associated PJIs is poor. 

Bone and joint infections often require prolonged antibiotic treatments over 12 weeks. Dalbavancin, an intravenous antibiotic given at spaced intervals, offers a promising option. Our study developed a method to optimize dosing schedules using two blood tests to measure drug levels. This ensures effective treatment while avoiding excessive accumulation. These findings suggest dalbavancin is a safe, effective choice for managing long-term infections.

We retrospectively compared outcomes of two-stage revision with three common spacer types. No significant difference in failure rate was seen across groups, contributing evidence of similar efficacy. Articulating spacers showed a greater range of motion than static spacers, and static spacers were associated with a higher adverse event rate, directly showing potential advantages and disadvantages of each variant. A trend toward a longer interstage duration for prosthetic spacers may reflect greater functionality.

This study's aim was to analyse the healing and failure rates of one-stage knee replacement in patients with positive and negative preoperative cultures and sinus presence.  We concluded that culture-negative infections or the presence of a sinus tract showed similar results compared to patients that had undergone the same procedure with positive cultures or spared soft tissue.

This retrospective study compared debridement and implant retention failure for three types of acute knee replacement infection and analyzed outcomes for patients in a cohort with low medical risk. No differences in failure rate were seen between types in the overall sample or “optimal” cohort. Staphylococcus aureus was less common in later infection, while Streptococcus was less frequent in earlier infection. In an optimal patient, similar outcomes between types may suggest that medical factors do not alter risk.