Radiograph of TKA with extensive instrumentation

What’s New in Musculoskeletal Infection 2022 

Recent studies on periprosthetic joint infection (PJI) and other topics are presented in the JBJS Guest Editorial What’s New in Musculoskeletal Infection.” Here, we spotlight the 5 most intriguing findings from the article, as selected by co-author Jesse E. Otero, MD, PhD. 

Irrigation and Debridement 

– The addition of a single dose of intraosseous vancomycin may increase the success of DAIR (debridement, antibiotics, and implant retention) in the treatment of PJI1. Among patients treated for acute infection following total knee arthroplasty, the rate of nonrecurrence was 92.3% (24 of 26) at a mean follow-up of 16 months. 

– A recent study in JBJS investigated PJI in complex revision total knee arthroplasty with extensive instrumentation2. The authors looked at whether PJI in such cases is better treated with 2-stage exchange or irrigation and debridement (I&D) with modular component exchange and antibiotic suppression. The authors found that I&D with chronic antibiotic suppression was as effective as 2-stage exchange at a mean of 3.2 years. 

Two-Stage Exchange 

– Another JBJS study evaluated the incidence, risk factors, and outcomes of acute kidney injuries in patients treated with a high-dose antibiotic-loaded bone cement (ALBC) spacer in 2-stage exchange for PJI following total knee arthroplasty3. The investigators found that 14% of the patients (52 of 359) with normal renal function at baseline developed acute kidney injuries, and 2% developed chronic kidney disease. 

Perioperative Antibiotics 

– Investigators found no increased risk of acute PJI following primary total joint arthroplasty in patients who received a single, preoperative prophylactic dose of antibiotic compared to those who received 24-hour prophylaxis4. This retrospective study included 3,317 patients. 

– Other researchers evaluated the use of extended oral antibiotics after primary total joint arthroplasty in patients with morbid obesity5. This single-center study found that a 7 to 14-day course of antibiotics did not decrease the risk of PJI or wound complications within 90 days postoperatively. 


What’s New in Musculoskeletal Infection” is freely available at 

What’s New by Subspecialty 

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at 

Recent OrthoBuzz posts include: “What’s New in Orthopaedic Trauma,” What’s New in Spine Surgery,” and “What’s New in Foot and Ankle Surgery.” 


  1. Kildow BJ, Patel SP, Otero JE, Fehring KA, Curtin BM, Springer BD, Fehring TK. Results of debridement, antibiotics, and implant retention for periprosthetic knee joint infection supplemented with the use of intraosseous antibiotics. Bone Joint J. 2021 Jun;103-B(6)(Supple A):185-90. 
  2. Barry JJ, Geary MB, Riesgo AM, Odum SM, Fehring TK, Springer BD. Irrigation and debridement with chronic antibiotic suppression is as effective as 2-stage exchange in revision total knee arthroplasty with extensive instrumentation. J Bone Joint Surg Am. 2021 Jan 6;103(1):53-63. 
  3. Dagneaux L, Limberg AK, Osmon DR, Leung N, Berry DJ, Abdel MP. Acute kidney injury when treating periprosthetic joint infections after total knee arthroplasties with antibiotic-loaded spacers: incidence, risks, and outcomes. J Bone Joint Surg Am. 2021 May 5;103(9):754-60. 
  4. Christensen DD, Moschetti WE, Brown MG, Lucas AP, Jevsevar DS, Fillingham YA; Dartmouth Hitchcock Medical Center. Perioperative antibiotic prophylaxis: single and 24-hour antibiotic dosages are equally effective at preventing periprosthetic joint infection in total joint arthroplasty. J Arthroplasty. 2021 Jul;36(7S):S308-13. 
  5. Carender CN, DeMik DE, Glass NA, Noiseux NO, Brown TS, Bedard NA. Do extended oral postoperative antibiotics prevent early periprosthetic joint infection in morbidly obese patients undergoing primary total joint arthroplasty? J Arthroplasty. 2021 Aug;36(8):2716-21. 

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