New research on musculoskeletal infection is highlighted in the JBJS Specialty Update What’s New in Musculoskeletal Infection. Here, we summarize the 5 most compelling studies, as selected by coauthor Özkan Köse, MD, PhD.
Treatment
A multicenter cohort study assessed quality-of-life outcomes in 498 patients with periprosthetic joint infection (PJI). Short Form-12 version 2 Physical Component Summary (PCS) scores were below the age-adjusted population norm at baseline through 24 months. A good functional outcome (PCS > 50 or an improvement of ≥8.9 points) was achieved in only 40% of patients despite successful PJI treatment1.
Prevention
PJI rates within 90 days after primary total hip arthroplasty (THA) were retrospectively studied in a matched cohort comprising 5,476 patients. Patients who received extended oral antibiotics following THA demonstrated a higher rate of PJI within 90 days2, “suggesting that prolonged prophylaxis may be counterproductive,” write Specialty Update authors Drs. Köse, Citak, and colleagues.
Diagnosis
Researchers compared the accuracy of 3 biomarkers—synovial calprotectin, synovial leukocyte count, and polymorphonuclear percentage (PMN%)—for the diagnosis of chronic PJI in a cohort of 137 patients undergoing revision hip or knee arthroplasty. With an area under the curve (AUC) of 0.96 and a negative predictive value of 100%, synovial calprotectin had the highest accuracy for ruling out chronic PJI3.
In a study including 412 patients undergoing revision arthroplasty, the utility of 4 standard-of-care serological tests as screening tools for PJI were evaluated: plasma D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen. D-dimer had the highest specificity of the 4 markers at a sensitivity of 100%, with a cutoff of ≥244 ng/mL4.
A new scoring system to guide reimplantation timing in patients with chronic knee PJI was proposed in a study published in JBJS. The scoring system, which had an AUC of 0.90, predicts the risk of infection recurrence using thresholds for D-dimer, synovial white blood-cell count, and PMN%. A total score of ≤2 suggests low risk and thus safe reimplantation, whereas a score of >2 cautions against reimplantation5.
What’s New in Musculoskeletal Infection is freely available at JBJS.org.
Read more: Access the November 19, 2025 special issue of JBJS centered on the theme of infection.
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 JBJS.org.
Recent OrthoBuzz posts include: What’s New in Orthopaedic Rehabilitation, What’s New in Shoulder and Elbow Surgery, and What’s New in Hip Surgery.
References
- Cooper D, Athan E, Yates P, Aboltins C, Davis JS, Manning L; Australasian Society for Infectious Diseases Clinical Research Network. How much does prosthetic joint infection and its successful treatment affect patient-reported quality of life? Clin Orthop Relat Res. 2025 Jan 1;483(1):160-70.
- Kubsad S, Collins AP, Dasari SP, Chansky HA, Fernando ND, Hernandez NM. Impact of extended prophylactic antibiotics on risk of prosthetic joint infection in primary total hip arthroplasty: a matched cohort analysis. J Am Acad Orthop Surg. 2025 Mar 15;33(6):307-12.
- Alkadhem MF, Ettema H, Wagenmakers-Huizenga LMF, Ploegmakers JJW, Muller Kobold AC, Wouthuyzen-Bakker M; Northern Infection Network of Joint Arthroplasty (NINJA). Synovial calprotectin is superior to synovial leukocyte count in excluding chronic periprosthetic joint infections, a retrospective cohort study. J Arthroplasty. 2024 Aug;39(8):1926-1931.e1.
- Tarabichi S, Lizcano JD, Abe EA, Goh GS, Baker CM, Parvizi J. Finding the optimal screening test for periprosthetic joint infection: a prospective study. J Arthroplasty. 2024 Aug;39(8):1919-1925.e2.
- Ascione T, Balato G, Festa E, Pandolfo G, Siciliano R, Pagliano P. Ideal timing of reimplantation in patients with periprosthetic knee infection undergoing 2-stage exchange: a diagnostic scoring system. J Bone Joint Surg Am. 2024 Jun 5;106(11):984-91.
