Orthopaedic infections: what have we learned?

Abstract

Orthopaedic infections remain challenging complications to treat, with profound economic impact in addition to patient morbidity. The overall estimates of infection after orthopaedic surgery with internal devices has been estimated at 5%, with hospital costs eight times that of those without fracture-related infections and with significantly poorer functional and pain interference PROMIS scores. Orthopaedic infection interventions have been focused on prevention and treatment options. The creation of new modalities for orthopaedic infection treatment can benefit from the understanding of the temporal relationship between bacterial colonization and host-cell integration, a concept referred to as "the race for the surface." Regarding prevention, host modulation and antibiotic powder use have been explored as viable options to lower infection rates. Orthopaedic infection treatment has additionally continued to evolve, with PO antibiotics demonstrating equivalent efficacy to IV antibiotics for the treatment of orthopaedic infections in recent studies. In conclusion, orthopaedic infections remain difficult clinical dilemmas, although evolving prevention and treatment modalities continue to emerge.

Keywords: basic science; infection; orthopaedic.

Figure 1.

Forest plot displaying efficacy of oral versus intravenous antibiotics for treatment of osteomyelitis. None of the highlighted studies have shown superiority of one treatment modality over the other. Note: The circle size represents the relative weight of an individual study's odds ratio within the overall meta-analysis, which is based on sample size and power analysis. The combined odds ratios are depicted by the shaded circle.

Figure 2.

There has been no difference in efficacy regarding infection eradication over multiple randomized controlled trials of antibiotics comparing short versus long treatment durations for varying infectious pathologies. CAP, community acquired pneumonia. GNR, gram-negative rod.