What’s New in Musculoskeletal Infection 2026

The latest research in musculoskeletal infection is presented in the new JBJS Specialty Update What’s New in Musculoskeletal Infection. Here, we summarize the 5 most impactful studies, as selected by coauthor Koji Yamada, MD, PhD. 

Prevention

A large multicenter randomized controlled trial (RCT) compared 3 interventions for infection prevention (local vancomycin powder, dilute povidone-iodine lavage, and a combination of vancomycin and povidone-iodine) against a control (normal saline lavage only) in high-risk total joint arthroplasty. The total hip cohort included 821 patients, and the total knee cohort included 1,080 patients. The 3-month rate of infection requiring revision did not differ significantly between the groups in either cohort<sup1. 

The association between β-lactam allergy, β-lactam antibiotics, and surgical site infection (SSI) was studied in a single-center cohort of 41,100 patients across 10 surgical specialties. Patients with a β-lactam allergy had a higher risk of SSI (risk ratio, 1.38; p = 0.003). The risk of SSI was higher with the use of non-β-lactam antibiotics compared with the use of β-lactam antibiotics (risk ratio, 1.69; p < 0.001)². 

Treatment

In a multicenter RCT of 233 patients with fracture-related infection, researchers compared the effectiveness of 6 weeks of oral vs. intravenous antibiotics with respect to the number of surgical interventions within 1 year. Oral administration was noninferior to intravenous administration in the modified intention-to-treat analysis but not in the adjusted per-protocol analysis³. As Specialty Update authors Drs. Yamada et al. comment in their summary of the literature, “these results challenge the routine requirement for prolonged intravenous therapy if effective bioavailable agents are available.” 

A double-blinded RCT evaluated the efficacy of antibiotic-impregnated, bioabsorbable calcium-sulphate granules in infection prevention in 20 patients undergoing surgical treatment of diabetic foot osteomyelitis. The trial was terminated early due to all postoperative infection-related complications occurring in the placebo group, a significant difference (5 of 10 vs. 0 of 10 patients; p = 0.01)⁴. “Despite the limitations related to sample size,” Drs. Yamada et al. write, “these findings reinforce the potential role of local antibiotic delivery as an adjunct to surgery in carefully selected patients.” 

Spinal Infection

A standardized definition for postoperative spinal infection was proposed in a modified Delphi consensus study by the Workgroup of the Musculoskeletal Infection Society and the European Bone & Joint Infection Society. The definition enables infection to be classified as definite or probable and is based on 6 clinical domains and stand-alone criteria⁵. 

What’s New in Musculoskeletal Infection is freely available at JBJS.org. 

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 Trauma, What’s New in Spine Surgery, and What’s New in Sports Medicine. 

References 

1. Saba BV, Higuera-Rueda CA, Dundon J, Cooper HJ, Dennis DA, Long WJ, Chen AF, Schwarzkopf R; VPIP Study Group. The three-month wound complication and infection rates after vancomycin powder and dilute povidone-iodine lavage for infection prophylaxis in high-risk total joint arthroplasty: a multicenter randomized controlled trial. J Arthroplasty. 2025 Sep;40(9S1):S487-94. 
2. Agarwal P, Kumar RP, Oleksiuk LM, Crall V, Petrov AA, McCreary EK, Holder-Murray J, Chang YF, Agarwal N, Hamilton DK, Friedlander RM. Non-β-lactam antibiotic use, β-lactam allergy, and surgical site infections. JAMA Surg. 2025 Nov 1;160(11):1260-7. 
3. Obremskey WT, O’Toole RV, Morshed S, Tornetta P 3rd, Murray CK, Jones CB, Scharfstein DO, Taylor TJ, Carlini AR, DeSanto JM, Castillo RC, Bosse MJ, Karunakar MA, Seymour RB, Sims SH, Weinrib DA, Churchill C, Carroll EA, Pilson HT, Goodman JB, Holden MB, Miller AN, Sietsema DL, Stahel PF, Mir H, Schmidt AH, Westberg JR, Mullis B, Shively KD, Hymes RA, Konda SR, Vallier HA, Breslin MA, Smith CS, Crickard CV, Reid JS, Baker M, Eglseder WA, LeBrun C, Manson T, Mascarenhas DC, Nascone J, Pollak AN, Schloss MG, Sciadini MF, Degani Y, Miclau T, Weiss DB, Yarboro SR, McVey ED, Firoozabadi R, Agel J, Burgos EJ, Gajari V, Rodriguez-Buitrago A, Tummuru RR, Trochez KM; Major Extremity Trauma Research Consortium (METRC). Oral vs intravenous antibiotics for fracture-related infections: the POvIV randomized clinical trial. JAMA Surg. 2025 Mar 1;160(3):276-84. 
4. Monami M, Bordoni L, Ragghianti B, Silverii GA, Mannucci E. Efficacy and safety of a bio-absorbable antibiotic delivery in calcium sulphate granules for the treatment of osteomyelitis in patients with diabetic foot: a randomized, double blinded, controlled clinical study The BIG D-FOOT study. Diabetes Obes Metab. 2025 May;27(5):2552-60. 
5. Shaw JD, Nelson SB, Simpfendorfer C, Berbari EF, Henry MW, Kleck CJ, Savage J, Agarwal N, Oyekan AA, Rodrigues-Pinto R, Wouthuyzen-Bakker M, Tande AJ. New definition for postoperative spine infection (PSI): from the Workgroup of the Musculoskeletal Infection Society (MSIS) and the European Bone & Joint Infection Society (EBJIS). Spine (Phila Pa 1976). 2025 Dec 23.