{"title":"A Promising Step Toward Molecular Diagnosis of PJI: Are We There Yet?: Commentary on an article by Bernhard J.H. Frank, MD, et al.: \"Synovial Fluid MicroRNA Biomarkers Enable Accurate Diagnosis of Hip and Knee Periprosthetic Joint Infections\".","authors":"Mansour Abolghasemian,Elissa Rennert-May","doi":"10.2106/jbjs.25.00916","DOIUrl":"https://doi.org/10.2106/jbjs.25.00916","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"6 1","pages":"2490-2491"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advances in the Prevention of Surgical Site Infection After Joint Replacement: Commentary on an article by the International Consensus Meeting Executive Committee: \"International Consensus Meeting on Infection. Top 10 Evidence-Backed Recommendations and Insights\".","authors":"Bassam A Masri","doi":"10.2106/jbjs.25.01071","DOIUrl":"https://doi.org/10.2106/jbjs.25.01071","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"70 1","pages":"2485"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond Words: Moving from Ideas to Action.","authors":"Mohit Bhandari","doi":"10.2106/jbjs.25.01092","DOIUrl":"https://doi.org/10.2106/jbjs.25.01092","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"466 1","pages":"2481-2482"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannes Keemu,Eetu Syystö,Riku Klén,Mikko S Venäläinen,Matias Hemmilä,Jutta Järvelin,Antti P Eskelinen,Keijo T Mäkelä
BACKGROUNDDebridement, antibiotics, and implant retention (DAIR) is the method of choice in the treatment of acute periprosthetic joint infection (PJI). However, the optimal timing of DAIR is somewhat unclear. We assessed the success of DAIR performed during different time intervals after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from the Finnish Arthroplasty Register (FAR).METHODSThere were 178,498 primary operations (78,888 THAs and 99,610 TKAs) from May 2014 to April 2022 recorded in the FAR. Male patients represented 53.4% of the THA group and 55.5% of the TKA group. The most common age group was ≤62 years in the THA group and ≥76 years in the TKA group. All patients were of Finnish ethnicity. A total of 1,014 DAIR procedures were performed within 6 months after the primary arthroplasty. Cases of reoperation after DAIR were followed for 1 year after the DAIR; re-revision due to PJI within 1 year was regarded as a failure of the DAIR treatment. We compared the failure rate of DAIR among 3 time intervals: 0 to 42, 43 to 84, and 85 to 180 days after the primary operation. A Cox regression model was used to assess risk factors for re-revision.RESULTSIn the THA group, the failure rate was 15.1% when DAIR was performed within 42 days, 10.0% when performed at 43 to 84 days, and 31.4% when performed at 85 to 180 days after the primary THA. In the TKA group, the failure rate was 8.9% when DAIR was performed within 42 days, 16.7% when performed at 43 to 84 days, and 9.8% when performed at 85 to 180 days after the primary TKA. Later DAIR was not associated with an increased re-revision risk, compared with the reference of 0 to 42 days, in the THA group (43 to 84 days: hazard ratio [HR], 1.2 [95% confidence interval (CI), 0.6 to 2.2; p = 0.63]; 85 to 180 days: HR, 1.4 [95% CI, 0.6 to 3.0; p = 0.41]). The same was true in the TKA group (43 to 84 days: HR, 1.0 [95% CI, 0.4 to 2.4; p = 0.98]; 85 to 180 days: HR, 1.9 [95% CI, 1.0 to 3.8; p = 0.065]).CONCLUSIONSThe failure rate of DAIR may not increase as much as previously thought if performed >6 weeks after primary total joint arthroplasty. Thus, DAIR can also be worth considering as a treatment method for PJI beyond the first 6 weeks postoperatively, depending on the severity of the case.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Timing of Debridement, Antibiotics, and Implant Retention for Early Periprosthetic Joint Infection: Data from the Finnish Arthroplasty Register.","authors":"Hannes Keemu,Eetu Syystö,Riku Klén,Mikko S Venäläinen,Matias Hemmilä,Jutta Järvelin,Antti P Eskelinen,Keijo T Mäkelä","doi":"10.2106/jbjs.25.00946","DOIUrl":"https://doi.org/10.2106/jbjs.25.00946","url":null,"abstract":"BACKGROUNDDebridement, antibiotics, and implant retention (DAIR) is the method of choice in the treatment of acute periprosthetic joint infection (PJI). However, the optimal timing of DAIR is somewhat unclear. We assessed the success of DAIR performed during different time intervals after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from the Finnish Arthroplasty Register (FAR).METHODSThere were 178,498 primary operations (78,888 THAs and 99,610 TKAs) from May 2014 to April 2022 recorded in the FAR. Male patients represented 53.4% of the THA group and 55.5% of the TKA group. The most common age group was ≤62 years in the THA group and ≥76 years in the TKA group. All patients were of Finnish ethnicity. A total of 1,014 DAIR procedures were performed within 6 months after the primary arthroplasty. Cases of reoperation after DAIR were followed for 1 year after the DAIR; re-revision due to PJI within 1 year was regarded as a failure of the DAIR treatment. We compared the failure rate of DAIR among 3 time intervals: 0 to 42, 43 to 84, and 85 to 180 days after the primary operation. A Cox regression model was used to assess risk factors for re-revision.RESULTSIn the THA group, the failure rate was 15.1% when DAIR was performed within 42 days, 10.0% when performed at 43 to 84 days, and 31.4% when performed at 85 to 180 days after the primary THA. In the TKA group, the failure rate was 8.9% when DAIR was performed within 42 days, 16.7% when performed at 43 to 84 days, and 9.8% when performed at 85 to 180 days after the primary TKA. Later DAIR was not associated with an increased re-revision risk, compared with the reference of 0 to 42 days, in the THA group (43 to 84 days: hazard ratio [HR], 1.2 [95% confidence interval (CI), 0.6 to 2.2; p = 0.63]; 85 to 180 days: HR, 1.4 [95% CI, 0.6 to 3.0; p = 0.41]). The same was true in the TKA group (43 to 84 days: HR, 1.0 [95% CI, 0.4 to 2.4; p = 0.98]; 85 to 180 days: HR, 1.9 [95% CI, 1.0 to 3.8; p = 0.065]).CONCLUSIONSThe failure rate of DAIR may not increase as much as previously thought if performed >6 weeks after primary total joint arthroplasty. Thus, DAIR can also be worth considering as a treatment method for PJI beyond the first 6 weeks postoperatively, depending on the severity of the case.LEVEL OF EVIDENCETherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"196 1","pages":"2554-2560"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mandated Patient-Reported Outcome Measures Driving Reimbursement for Arthroplasties: A Disturbing New Reality for Orthopaedic Surgeons.","authors":"Adam Rana,Antonia F Chen,Catherine Call","doi":"10.2106/jbjs.25.00844","DOIUrl":"https://doi.org/10.2106/jbjs.25.00844","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"94 1","pages":"2504-2507"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Synovial Myeloperoxidase: Another Biomarker or a Novel Addition in the Quest for Accurate and Timely PJI Diagnosis?: Commentary on an article by Shinsuke Ikeda, MD, PhD, et al.: \"Diagnostic Utility of a Rapid Myeloperoxidase Test in Synovial Fluid for Chronic Periprosthetic Joint Infection\".","authors":"Kyle H Cichos","doi":"10.2106/jbjs.25.00698","DOIUrl":"https://doi.org/10.2106/jbjs.25.00698","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"200 1","pages":"2492-2493"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"\"Oops, I Did It Again\": Commentary on an article by Jocelyn Corbaz, MD, et al.: \"Chemical Disinfection of an Accidentally Contaminated and Irreplaceable Inorganic Element During Orthopaedic Surgery Is a Safe Option\".","authors":"Thomas J Fischer","doi":"10.2106/jbjs.25.01008","DOIUrl":"https://doi.org/10.2106/jbjs.25.01008","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":"2494"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rudolf W Poolman,Jacob J Caron,Sebastiaan A W van de Groes,Cornelis Leendert Pieter van de Ree,Bart G Pijls
{"title":"World Report: A Snapshot of Orthopaedic Surgery in The Netherlands.","authors":"Rudolf W Poolman,Jacob J Caron,Sebastiaan A W van de Groes,Cornelis Leendert Pieter van de Ree,Bart G Pijls","doi":"10.2106/jbjs.25.00919","DOIUrl":"https://doi.org/10.2106/jbjs.25.00919","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"1 1","pages":"2517-2520"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Holidays May Not Be Needed: Commentary on an article by Andrew Fraval, MBBS, MPH, et al.: \"Antibiotic Holiday in 2-Stage Exchange for Periprosthetic Joint Infection. A Scoping Review\".","authors":"Martin A Buttaro,Carlos Lucero","doi":"10.2106/jbjs.25.00157","DOIUrl":"https://doi.org/10.2106/jbjs.25.00157","url":null,"abstract":"","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"70 1","pages":"2483-2484"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jocelyn Corbaz,Dominique S Blanc,Bruno Grandbastien,Olivier Borens
BACKGROUNDDuring surgical procedures, the accidental contamination of a critical instrument or implant can jeopardize the entire operation. Resterilizing the item is not always feasible and can be time-consuming. Since extending the duration of the surgery heightens the risk of postoperative complications, it is essential to balance this risk with the risk of infection from contamination. Currently, there is no simple, safe, and quickly available method to address this issue. This study explored the efficacy of using chemical disinfection to deal with this problem.METHODSIn part 1 of the study, 3 types of discs (cobalt-chromium, titanium, and polyethylene) were contaminated with Staphylococcus epidermidis, disinfected with use of 3 different procedures (2% chlorhexidine in 70% isopropanol alcohol, 0.9% povidone-iodine in 46% isopropanol alcohol, or 70% ethanol), and analyzed for remaining bacteria. A control group without disinfection was included. In part 2, the discs were dropped on the floor of an operating room, left on the floor for 30 seconds, and then collected before undergoing the same procedure as in part 1.RESULTSIn part 1, all 3 alcohol-based disinfection procedures showed a high efficacy, as there was no growth found on any of the discs. These results were highly significant compared with those found for the control group (p < 0.01 for all). In the control group, polyethylene had the highest mean level of contamination (157.3 colony-forming units [CFUs]) and titanium had the lowest (58.4 CFUs). Part 2 confirmed the effectiveness of alcohol-based disinfection, with no growth observed in the test cultures. In the control group, polyethylene seemed to be the most prone to contamination. However, the level of contamination was low for all materials (0 to 8 CFUs per disc).CONCLUSIONSIn the event of accidental contamination of an essential element or implant during a surgical procedure with no possibility of replacing the element, 2 minutes of disinfection in an alcohol-based solution seems to be a safe, simple, and quick option.CLINICAL RELEVANCEIn the event of accidental contamination of an irreplaceable inorganic element during orthopaedic surgery, we recommend soaking the element in an alcohol-based disinfectant for 2 minutes and rinsing it with saline solution.
{"title":"Chemical Disinfection of an Accidentally Contaminated and Irreplaceable Inorganic Element During Orthopaedic Surgery Is a Safe Option.","authors":"Jocelyn Corbaz,Dominique S Blanc,Bruno Grandbastien,Olivier Borens","doi":"10.2106/jbjs.24.01163","DOIUrl":"https://doi.org/10.2106/jbjs.24.01163","url":null,"abstract":"BACKGROUNDDuring surgical procedures, the accidental contamination of a critical instrument or implant can jeopardize the entire operation. Resterilizing the item is not always feasible and can be time-consuming. Since extending the duration of the surgery heightens the risk of postoperative complications, it is essential to balance this risk with the risk of infection from contamination. Currently, there is no simple, safe, and quickly available method to address this issue. This study explored the efficacy of using chemical disinfection to deal with this problem.METHODSIn part 1 of the study, 3 types of discs (cobalt-chromium, titanium, and polyethylene) were contaminated with Staphylococcus epidermidis, disinfected with use of 3 different procedures (2% chlorhexidine in 70% isopropanol alcohol, 0.9% povidone-iodine in 46% isopropanol alcohol, or 70% ethanol), and analyzed for remaining bacteria. A control group without disinfection was included. In part 2, the discs were dropped on the floor of an operating room, left on the floor for 30 seconds, and then collected before undergoing the same procedure as in part 1.RESULTSIn part 1, all 3 alcohol-based disinfection procedures showed a high efficacy, as there was no growth found on any of the discs. These results were highly significant compared with those found for the control group (p < 0.01 for all). In the control group, polyethylene had the highest mean level of contamination (157.3 colony-forming units [CFUs]) and titanium had the lowest (58.4 CFUs). Part 2 confirmed the effectiveness of alcohol-based disinfection, with no growth observed in the test cultures. In the control group, polyethylene seemed to be the most prone to contamination. However, the level of contamination was low for all materials (0 to 8 CFUs per disc).CONCLUSIONSIn the event of accidental contamination of an essential element or implant during a surgical procedure with no possibility of replacing the element, 2 minutes of disinfection in an alcohol-based solution seems to be a safe, simple, and quick option.CLINICAL RELEVANCEIn the event of accidental contamination of an irreplaceable inorganic element during orthopaedic surgery, we recommend soaking the element in an alcohol-based disinfectant for 2 minutes and rinsing it with saline solution.","PeriodicalId":22625,"journal":{"name":"The Journal of Bone & Joint Surgery","volume":"29 1","pages":"2582-2587"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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