https://jbji.copernicus.org/articles/ Recent articles of the journal Journal of Bone and Joint Infection https://doi.org/10.5194/jbji-11-565-2026 <b>Clinical case of polymicrobial and multidrug-resistant posttraumatic chronic hip infection treatment</b><br> Urban Vadnjal, Samo Roškar, René Mihalič, Mitja Rak, and Rihard Trebše<br> J. Bone Joint Infect., 11, 565–568, https://doi.org/10.5194/jbji-11-565-2026, 2026<br> The case demonstrates the importance of having well-established hospital algorithms for fracture related infection (FRI)/periprostheticjoint infection (PJI) treatment and strictly following them at each step. In most severe cases related to multidrug-resistant (MDR) bacteria, a multiple-stage protocol is indicated, and intra-articular infusions of antibiotics should be considered in addition to standard intravenous regimens. 2026-09-10T22:26:20+02:00 https://doi.org/10.5194/jbji-11-555-2026 <b>Sonication versus peri-implant tissue culture in fracture-related infection: diagnostic performance and therapeutic consequences in a single-center cohort</b><br> Belal Abdo, Daniel Strack, Marcel Schäuffele, Tim Ludwig Tüngler, Can Imirzalioglu, Anita Windhorst, Moritz Fritzenwanker, Christian Heiss, and Markus Rupp<br> J. Bone Joint Infect., 11, 555–563, https://doi.org/10.5194/jbji-11-555-2026, 2026<br> Fracture-related infections after bone surgery are difficult to diagnose because bacteria can attach to metal implants and become hard to detect, especially when antibiotics have already been given. We compared two laboratory methods used to identify bacteria on removed implants in 157 patients. Each method alone missed some infections, but using both together improved detection and helped guide antibiotic treatment. Our findings support combining diagnostic approaches to improve patient care. 2026-08-26T22:26:20+02:00 https://doi.org/10.5194/jbji-11-547-2026 <b>Periprosthetic fractures around chronically infected total hip arthroplasties: a case series and pragmatic two-stage treatment framework</b><br> Georges F. Vles, Willem-Jan Metsemakers, Laurens Aerden, Jan Geurts, Oliver Borens, and Stijn Ghijselings<br> J. Bone Joint Infect., 11, 547–554, https://doi.org/10.5194/jbji-11-547-2026, 2026<br> We studied three patients who had both a broken femur and a long-standing infection around an artificial hip, a rare and difficult problem. We treated them in two steps: first removing the implant, cleaning the infection, stabilizing the bone, and placing a temporary bone cement spacer; and then reimplanting the hip prosthesis once infection was controlled. In all cases, the infection cleared, the bone healed, and function improved. This approach may offer a safe way to manage these complex cases. 2026-08-25T22:26:20+02:00 https://doi.org/10.5194/jbji-11-535-2026 <b>Feasibility of a rat femoral-defect model for immediate perioperative and delayed post-implantation implant-associated bone infections</b><br> Pardis Keikhosravani, Michiel Croes, Nada Ristya Rahmani, Flurina Stabuli, Leonardo Cecotto, H. Charls Vogely, Bart C. H. van der Wal, Marianne Koolen, Debby Gawlitta, Harrie Weinans, Azin Khodaei, and Saber Amin Yavari<br> J. Bone Joint Infect., 11, 535–546, https://doi.org/10.5194/jbji-11-535-2026, 2026<br> This study delivers a practical rat model for both early and delayed implant‑site infections. We show which bacterial doses and states produce consistent infections at each time point, creating a dependable platform to evaluate new materials and treatments that prevent or clear implant infections.  2026-08-25T22:26:20+02:00 https://doi.org/10.5194/jbji-11-523-2026 <b>Socioeconomic burden of septic re-revision surgeries for periprosthetic joint infections in Europe – a comprehensive analysis of re-revision costs</b><br> Dominik Szymski, Susanne Baertl, Nike Walter, Markus Rupp, Katja Hierl, and Volker Alt<br> J. Bone Joint Infect., 11, 523–533, https://doi.org/10.5194/jbji-11-523-2026, 2026<br> A health-economic study estimating the cost of septic re-revision surgery for periprosthetic joint infections (PJIs) across 30 European countries. Using 2023 Eurostat data plus a 13-country reimbursement survey, the study estimates 22 794 PJIs and 8629 septic re-revisions in 2023, costing ~€123.6 million (95% CI €102–156 million). Two-stage exchanges drive 82.8% of costs. Cutting PJI incidence by 25% could save €27.9 million/year; shifting half of two-stage cases to one-stage a further €22.6 million. 2026-08-24T22:26:20+02:00 https://doi.org/10.5194/jbji-11-513-2026 <b>Reinfection and complication rates in two-stage revision for chronic hip periprosthetic joint infections using the direct anterior approach</b><br> Sebastian Simon, Jennyfer A. Mitterer, Bernhard J. H. Frank, Stephanie Huber, Sujeesh Sebastian, Susana Gardete-Hartmann, and Jochen G. Hofstaetter<br> J. Bone Joint Infect., 11, 513–521, https://doi.org/10.5194/jbji-11-513-2026, 2026<br> Two-stage septic revision was evaluated in 36 / 8476 (0.4 %) patients after primary total hip arthroplasty (THA) using the direct anterior approach (DAA). Infection-free survival was 77.8 % after a median follow-up of 6 years. Spacer-related complications occurred in 5.6 %. Revision for dislocation after reimplantation occurred in 8.3 %. Two-stage septic revision using the DAA shows reinfection rates comparable to other approaches, with low rates of spacer dislocation and postoperative dislocation after reimplantation. 2026-08-19T22:26:20+02:00 https://doi.org/10.5194/jbji-11-503-2026 <b>Postoperative inflammatory markers and surgical wound infection after elective short-segment lumbar fusion: the importance of surgical context</b><br> Jay Chung, Ta'ir Rocker, Regina Golding, Sachin Mehta, Madison McFarland, Arjun Gupta, Xiuyi Yang, Priya Singh, Evan Olsen, Shreya Balusu, Yungtai Lo, Pamela Zuckerman, Jeremy D. Shaw, and Mitchell S. Fourman<br> J. Bone Joint Infect., 11, 503–511, https://doi.org/10.5194/jbji-11-503-2026, 2026<br> After elective short-segment lumbar fusion, inflammatory blood markers measured on the first postoperative day were strongly influenced by patient and operative factors. Day-three white blood cell count and the neutrophil-to-lymphocyte ratio showed exploratory associations with wound-related events, but these weakened after accounting for day-one values. The findings do not establish diagnostic thresholds and require prospective validation. 2026-08-18T22:26:20+02:00 https://doi.org/10.5194/jbji-11-493-2026 <b>In vitro analysis of antiseptic solution effects on Staphylococcus aureus biofilms on orthopedic implant materials</b><br> Madison Balagtas, Kenneth Chrulski, Marina Feffer, Matthew Baldridge, and Ashley E. Levack<br> J. Bone Joint Infect., 11, 493–501, https://doi.org/10.5194/jbji-11-493-2026, 2026<br> Bacterial infections on orthopedic implants are difficult to treat because bacteria form protective biofilms. We tested antiseptic solutions against Staphylococcus aureus biofilms on stainless steel. Povidone-iodine achieved the greatest reduction, exceeding 99.9% bacterial killing. Dilute povidone-iodine performed as well as full-strength, important since lower concentrations reduce tissue toxicity. Hypochlorous acid and chlorhexidine showed lower activity, while saline was minimally effective. 2026-08-13T22:26:20+02:00 https://doi.org/10.5194/jbji-11-489-2026 <b>Isolation policies in musculoskeletal infection care: time to move from tradition to evidence</b><br> Laura Bessems, Jolien Onsea, Marjan Wouthuyzen-Bakker, Irene K. Sigmund, Tristan Ferry, Richard Kuehl, Martin Clauss, Alex Soriano, Ricardo Sousa, Annette Schuermans, and Willem-Jan Metsemakers<br> J. Bone Joint Infect., 11, 489–492, https://doi.org/10.5194/jbji-11-489-2026, 2026<br> We examined whether patients with musculoskeletal infections need to be separated in hospital. A review of published studies found no support for routine isolation or dedicated wards for infections without multidrug-resistant organisms when standard precautions are applied. An international survey showed wide variation in clinician attitudes. These findings highlight a gap between evidence and perception and support a more risk-based approach. 2026-08-07T22:26:20+02:00 https://doi.org/10.5194/jbji-11-479-2026 <b>Culture-negative periprosthetic joint infection: an umbrella review of prevalence, diagnostic strategies, treatment, and methodological limitations</b><br> Guido Bocchino, Giulio Maccauro, Andrea Zampoli, Rocco Papalia, Pier Francesco Indelli, Daniel Pérez-Prieto, and Javad Parvizi<br> J. Bone Joint Infect., 11, 479–488, https://doi.org/10.5194/jbji-11-479-2026, 2026<br> The current umbrella review showed that prevalence, diagnostic performance of adjunctive molecular methods, treatment strategies, and outcomes vary substantially. Molecular diagnostics appear to be promising as adjunctive tools in selected cases, but their interpretation requires caution, and they do not resolve all uncertainties related to culture-negative periprosthetic joint infections.  2026-08-03T22:26:20+02:00 https://doi.org/10.5194/jbji-11-463-2026 <b>Timing from admission to debridement, antibiotic, and implant retention (DAIR) affects mortality risk in total hip prosthetic joint infections</b><br> Jack Legler, Samuel Morgan, Paul Beaulé, Hesham Abdelbary, George Grammatopoulos, and Simon Garceau<br> J. Bone Joint Infect., 11, 463–477, https://doi.org/10.5194/jbji-11-463-2026, 2026<br> We studied patients with infected hip replacements to determine whether delays between hospital admission and  surgery affected recovery. By reviewing patient records from a specialty center, we found that longer delays were linked to a higher risk of death within 90 d. Older age, poorer overall health, and low blood levels also increased the chance of complications or repeat surgery. These results suggest that prompt treatment and careful health preparation can improve outcomes.  2026-08-03T22:26:20+02:00 https://doi.org/10.5194/jbji-11-453-2026 <b>Rapid molecular culture versus conventional culture for periprosthetic joint infection: diagnostic performance and clinical relevance</b><br> Elizabeth Morreel, Paul Savelkoul, and Inge van Loo<br> J. Bone Joint Infect., 11, 453–462, https://doi.org/10.5194/jbji-11-453-2026, 2026<br> Joint replacement infections are difficult to diagnose quickly because standard laboratory cultures can take days to weeks and may miss bacteria after antibiotic treatment. We evaluated a rapid molecular test using fluid from removed implants and found that it provided clinically useful results within hours. This approach may help doctors exclude infection sooner, reduce unnecessary antibiotic use, and improve patient care. 2026-07-31T22:26:20+02:00 https://doi.org/10.5194/jbji-11-441-2026 <b>Bromelain and N-acetylcysteine (BromAc) as novel adjunctive therapy for prosthetic joint infection: a narrative review</b><br> Brendan Parnell and David Morris<br> J. Bone Joint Infect., 11, 441–451, https://doi.org/10.5194/jbji-11-441-2026, 2026<br> Prosthetic joint infections are devastating complications of joint replacements, often resisting antibiotics because bacteria hide inside a protective slime called biofilm. We reviewed laboratory evidence on BromAc, a combination of a pineapple enzyme and a mucus-thinning agent that breaks down this slime. Early experiments suggest it can disrupt biofilm and improve antibiotic access, but key questions about safety, stability, and joint-specific testing must be answered before patient use. 2026-07-28T22:26:21+02:00 https://doi.org/10.5194/jbji-11-431-2026 <b>Sonication fluid cultures enhance pathogen identification in fracture-related-infection (FRI)</b><br> Anas Zouitni, Erlangga Yusuf, Jakob van Oldenrijk, Tjebbe Hagenaars, Peter D. Croughs, P. Koen Bos, Denise Eygendaal, and Ewout S. Veltman<br> J. Bone Joint Infect., 11, 431–440, https://doi.org/10.5194/jbji-11-431-2026, 2026<br> This study explores the diagnostic value of sonication fluid culture (SFC) as an adjunct to conventional diagnostic methods for fracture-related infection (FRI). SFC improves pathogen detection and contributes to more accurate diagnosis of FRI. In approximately 6 % to 16 % of confirmed FRI cases, SFC influenced FRI management. These findings support the routine use of SFC alongside standard tissue cultures, with adequate sampling according to protocol. 2026-07-20T22:26:21+02:00 https://doi.org/10.5194/jbji-11-413-2026 <b>Management and outcomes of culture-negative periprosthetic joint infection: a systematic review and meta-analysis</b><br> Farzad Pourghazi, Seyed Mohammad Amin Alavi, Takahiro Matsuo, Georges Baaklini, Matthew P. Abdel, Aaron J. Tande, and Elie F. Berbari<br> J. Bone Joint Infect., 11, 413–430, https://doi.org/10.5194/jbji-11-413-2026, 2026<br> Culture-negative periprosthetic joint infection (CN-PJI) remains a diagnostic and therapeutic challenge. In this systematic review and meta-analysis of 27 studies (1399 patients), pooled success was 83.6 %, failure was 17.2 %, and mortality was 2.4 %. Outcomes were better with exchange arthroplasty than debridement, antimicrobials, and implant retention (DAIR). Antibiotic regimens were heterogeneous. Overall, CN-PJI may have favorable outcomes, but standardized prospective studies are needed. 2026-07-14T22:26:21+02:00 https://doi.org/10.5194/jbji-11-401-2026 <b>Management of fracture-related infection in low-resource settings in Africa: recommendations and guidelines from an international expert group</b><br> Loïc Fonkoué, Elizabeth K. Tissingh, Leonard C. Marais, Mbonisi Malaba, Kidanemariam Abrha, Jamie Ferguson, Mario Morgenstern, Olivier Cornu, Maritz Laubscher, Randy Buzisa Mbuku, George W. Galiwango, Matthijs Botman, Justyna Wojno, Mtebe Venance Majigo, Claude Martin Jr., William James Harrison, Alexander Thomas Schade, Kebba Marenah, Malvern Nyamutora, Phiona E. Namale, Vuyisa Mdingi, and Martin McNally<br> J. Bone Joint Infect., 11, 401–411, https://doi.org/10.5194/jbji-11-401-2026, 2026<br> Fracture-related infection is a serious problem after broken bones, especially in low-resource settings where specialist care and services are limited. An international expert group developed practical recommendations adapted to these realities. The guidance focuses on early fracture care, simple diagnostic approaches, flexible antibiotic use, affordable local treatments, good soft tissue management, and teamwork, aiming to improve safe and effective care in resource-limited environments. 2026-07-09T22:26:21+02:00 https://doi.org/10.5194/jbji-11-395-2026 <b>Literature review and case report on the use of rezafungin for spondylodiscitis in an outpatient parenteral antimicrobial therapy (OPAT) setting</b><br> Alexander J. Richards, Ammara Asif, Monica Ivan, Patrick J. Lillie, Gavin Barlow, and Chloe Walsh<br> J. Bone Joint Infect., 11, 395–400, https://doi.org/10.5194/jbji-11-395-2026, 2026<br> Fungal infection can be difficult to treat, requiring long periods of hospitalisation. Rezafungin is a promising new antifungal medication that can be used to treat complex, deep-seated fungal infection. We examine the reported use of rezafungin in managing fungal infection of the bones and joints in an outpatient setting. Our case helps to provide further experience in the use of rezafungin as a powerful tool in helping patients get out of hospital and avoid further admissions. 2026-07-06T22:26:21+02:00 https://doi.org/10.5194/jbji-11-387-2026 <b>Changes in systemic immune–inflammation index predict periprosthetic joint infection after hemiarthroplasty in elderly patients</b><br> Emre Bilgin, Onur Gultekin, Murat Kilic, Umit Burak Alparslan, Mehmet Berke Yusan, and Ahmet Onur Akpolat<br> J. Bone Joint Infect., 11, 387–394, https://doi.org/10.5194/jbji-11-387-2026, 2026<br> We looked at whether routine blood tests could help identify patients at higher risk of infection after hip fracture surgery. Using data from a large group of older patients, we found that higher inflammation levels after surgery, especially when they increased compared to before surgery, were linked to a greater risk of infection. This suggests that simple and widely available tests may help clinicians recognize high-risk patients earlier and guide closer follow-up. 2026-07-03T22:26:21+02:00 https://doi.org/10.5194/jbji-11-373-2026 <b>Integrating molecular and conventional diagnostics in native vertebral osteomyelitis: a narrative review</b><br> Farzad Pourghazi, Omar Mahmoud, Francesco Petri, Said El Zein, Gina A. Suh, Takahiro Matsuo, Andrea Gori, Audrey N. Schuetz, and Elie F. Berbari<br> J. Bone Joint Infect., 11, 373–385, https://doi.org/10.5194/jbji-11-373-2026, 2026<br> Native vertebral osteomyelitis, a spinal bone infection, is difficult to diagnose, and delays can worsen outcomes. This review examines how traditional laboratory tests and newer genetic techniques can be integrated to improve identification of the responsible microorganism. We show that combining these approaches within the diagnostic pathway may increase accuracy and support earlier diagnosis, enabling more timely and informed treatment decisions. 2026-06-29T22:26:21+02:00 https://doi.org/10.5194/jbji-11-363-2026 <b>Neutrophil extracellular trap (NET)-related index as an indicator of periprosthetic joint infection</b><br> Tingrun Cui, Yongjian Liang, Zeyu Feng, Libo Hao, Guoqiang Zhang, Ming Ni, Jing Sheng, Dihua Shangguan, Jiying Chen, and Jun Fu<br> J. Bone Joint Infect., 11, 363–371, https://doi.org/10.5194/jbji-11-363-2026, 2026<br> Periprosthetic joint infection is the most challenging complication following arthroplasty. This study, utilizing clinically obtained synovial fluid specimens, confirmed the unique value of neutrophil extracellular traps and their constituent components in the diagnosis of periprosthetic joint infection, thereby enabling further precision in the diagnosis of periprosthetic joint infection and reducing the severe consequences associated with it. 2026-06-22T22:26:21+02:00