What’s New in Musculoskeletal Infection 2021

Every month, JBJS publishes a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 14 subspecialties. Click here for a collection of all such OrthoBuzz specialty-update summaries.

This month, co-author Thomas K. Fehring, MD summarizes the 5 most compelling findings from the >90 studies highlighted in the recently publishedWhat’s New in Musculoskeletal Infection.”

Albumin and Complication Risk

One recent study evaluated the effect of albumin levels on complications following primary and revision total joint arthroplasties (shoulder, elbow, wrist, hip, knee, ankle, or fingers). Patients with lower albumin levels preoperatively were at significantly increased risk for infection, pneumonia, sepsis, and other adverse outcomes compared with patients with normal albumin levels.

Antibiotic Prophylaxis and SSI Risk

–A retrospective cohort study using data from 436,724 total hip arthroplasty (THA) and 862,918 total knee arthroplasty (TKA) procedures examined antibiotic prophylaxis patterns and surgical site infection (SSI) risk1. Patients who received IV antibiotics other than cefazolin preoperatively had a higher risk of SSI.

Corticosteroid Injections and PJI

– A study using a large national database found that patients who underwent TKA and received a postoperative intra-articular corticosteroid injection (5,628 of 166,946 TKAs, 3.4%) had a significantly higher rate of periprosthetic joint infection (PJI) compared with a matched control cohort who did not receive an injection2.

Two-Stage Exchange

–A multicenter randomized controlled trial found that a 3-month course of microorganism-directed oral antibiotics significantly reduced the rate of failure from further infection after 2-stage revision of THA or TKA for chronic PJI3. Among 185 patients, treatment success was achieved for 87.5% of the patients who received 3 months of antibiotics vs 71.4% of those who did not.

Oral Antibiotics in Revision Arthroplasty

–Another multicenter randomized controlled trial evaluated the utility of adding rifampin to conventional antimicrobial therapy in cases of staphylococcal PJI treated with debridement and retention of the implant4. No significant advantage of adding rifampin to standard antibiotic therapy was found.


  1. Zastrow RK, Huang HH, Galatz LM, Saunders-Hao P, Poeran J, Moucha CS. Characteristics of antibiotic prophylaxis and risk of surgical site infections in primary total hip and knee arthroplasty. J Arthroplasty. 2020 Sep;35(9):2581-9. Epub 2020 Apr 18.
  2. Roecker Z, Quinlan ND, Browne JA, Werner BC. Risk of periprosthetic infection following intra-articular corticosteroid injections after total knee arthroplasty. J Arthroplasty. 2020 Apr;35(4):1090-4. Epub 2019 Nov 16.
  3. Yang J, Parvizi J, Hansen EN, Culvern CN, Segreti JC, Tan T, Hartman CW, Sporer SM, Della Valle CJ; Knee Society Research Group. 2020 Mark Coventry Award: microorganism-directed oral antibiotics reduce the rate of failure due to further infection after two-stage revision hip or knee arthroplasty for chronic infection: a multicentre randomized controlled trial at a minimum of two years. Bone Joint J. 2020 Jun;102-B(6_Supple_A):3-9.
  4. Karlsen ØE, Borgen P, Bragnes B, Figved W, Grøgaard B, Rydinge J, Sandberg L, Snorrason F, Wangen H, Witsøe E, Westberg M. Rifampin combination therapy in staphylococcal prosthetic joint infections: a randomized controlled trial. J Orthop Surg Res. 2020 Aug 28;15(1):365.

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