Patients who undergo repeat surgery due to joint infection after a hip or knee replacement have a higher risk of dying compared with those who have revision surgery for other reasons. We studied more than 9000 patients using national health data to explore why this happens. We found that the higher risk cannot be explained by a single cause of death but is linked to many common health problems. This suggests that these patients are especially vulnerable and may need broader medical support.

A total of 51 studies were reviewed to compare the alpha-defensin enzyme-linked immunosorbent assay (ELISA) and the lateral flow test for diagnosing joint replacement infections. Both tests are highly specific and accurately confirm infection, but ELISA showed greater sensitivity (87.8 % vs. 81.8 %), making it better for detection. These findings support the continued use of ELISA as the preferred diagnostic method.

This study evaluated the effectiveness of systemic antibiotic therapy against S. aureus and P. aeruginosa biofilm-associated infections in a large animal (ovine) model of fracture-related infection (FRI). Systemic therapy reduced some bacterial load, but most samples did not significantly differ from positive controls. Histological findings corroborated persistent infection. These results validate the model and underscore the limitations of systemic therapy in effectively managing FRI.

This study performed an external validation of the so-called JS-BACH classification from 2021, which aims to help predict the outcome of periprosthetic joint infections using three groups of increasing severity. Using data from 249 patients, we found that higher severity scores were strongly linked to an increased failure rate. This simple tool could guide doctors in tailoring treatments and improving results for patients with these challenging infections.

Isolation of patients with musculoskeletal infections in orthopedic care is controversial. Evidence supports selective isolation for certain resistant pathogens but not for non-resistant pathogens, nor does it support the routine use of septic wards. Effective infection control depends on hospital-wide strategies and adherence to standard precautions, with specialized centres offering better care than dedicated isolation units.

This single-center retrospective study focused on the utility of modular megaprostheses in patients with chronic hip or knee periprosthetic joint infections. Among the 61 included patients, 37.7 % experienced any type of failure, with infection recurrence being the most common reason. While infection control was acceptable, the rates of any-type failure were high. Moreover, patients classified as McPherson host grade C, representing compromised hosts, are at greater risk of experiencing failure.

This study looked at infections in people with prosthetic joints and found that a type of bacteria called anaerobes is often overlooked but causes more infections than expected, especially in the shoulder. These infections tend to last longer and present differently compared to typical ones. The findings suggest that doctors should always check for anaerobic bacteria when diagnosing joint infections, especially when symptoms are long-lasting or involve the shoulder.

Periprosthetic joint infection  (PJI) is a serious complication of oncologic joint reconstructions with large endoprosthetics. Although the microbiology of PJI in conventional joint replacements is well characterized, it is lacking for oncologic patients. This study found that the microbiology of oncologic PJI is distinct from conventional joint replacement PJI and that microbiology varies in different cancer subpopulations. These findings will help improve targeted antibiotic treatment for PJI.

The rising rate of spinal surgeries has led to more postoperative infections, yet no standardized diagnostic criteria exist. We analyzed over 100 studies and found considerable variation in definitions. Our findings underscore the need for a unified diagnostic framework that integrates clinical signs, laboratory data, and imaging to enhance diagnostic accuracy, support clinical decision-making, and improve consistency in future research.

Patients with bone and joint infections are often sent home before all test results are final. We created a new team-based process to review these results after discharge and take action if needed. In over one-third of cases, changes to treatment were made, some of which prevented serious harm. This approach improves patient safety and shows how teamwork and follow-up after hospital stays can make a meaningful difference in care.

The novel multiplex polymerase chain reaction (mPCR), BioFire® Joint Infection Panel (BF-JIP; bioMérieux, Marcy-l’Étoile, France), demonstrated similar diagnostic accuracy to conventional synovial fluid culture and can therefore serve as a valuable adjunct in diagnosing septic arthritis in adults, particularly in patients with prior antimicrobial therapy.

We studied a serious double infection affecting the heart and spine, often seen in older or immunocompromised patients. By analyzing systematic data from the literature, we found that this condition leads to high death rates, especially when caused by the bacterium Staphylococcus aureus. Our work highlights the urgent need for higher-quality studies and better coordinated care. These findings may help guide future treatment strategies and improve outcomes for affected patients.

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.