Diagnostics, Antibiotic Usage and Surgery Related Techniques in Prevention and Treatment of Prosthetic Joint and Implant Related Infections

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 1282

Special Issue Editors


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Guest Editor
Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Markgröningen, Germany
Interests: primary and revision joint arthroplasty of hip and knee; diagnostics and therapy of bone and joint infections
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Guest Editor
Center for Orthopedics and Trauma Surgery, University Hospital of Marburg, Marburg, Germany
Interests: the care of severe injuries; orthopedics and trauma surgery; special trauma surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prosthetic joint infections (PJIs) remain among the most serious and complex complications that can follow joint arthroplasty, particularly in hip and knee replacements. With the global increase in both primary and revision joint arthroplasty procedures, the incidence and clinical burden of PJIs are growing. These infections not only compromise patient outcomes but also pose substantial challenges to orthopedic surgeons and infectious disease specialists alike.

The accurate and timely diagnosis of PJIs is crucial. Advances in imaging, molecular diagnostics, and biomarker identification are improving our ability to detect infections early and implement targeted therapy. Still, there remains a need for standardized diagnostic criteria and personalized treatment strategies, especially in the setting of multidrug-resistant organisms and recurrent infections.

Antibiotic usage plays a pivotal role throughout the continuum of care—from prophylaxis during primary arthroplasty to salvage procedures in complex revision cases. While perioperative antibiotic prophylaxis has significantly reduced infection rates in primary procedures, managing infections in revision arthroplasty is markedly more complicated due to factors such as antibiotic resistance and the formation of biofilms on implants.

Equally critical are surgical techniques for preventing and treating PJI and FRI. Skin preparation, irrigation solutions, and debridement techniques are some examples of these.

This Special Issue focuses on antibiotic strategies in primary and revision joint arthroplasty and the evolving landscape of diagnostics and therapies for bone and joint infections. Original articles and meta-analyses in both clinical and basic research are welcome, as well as review articles that summarize the newest knowledge in the field.

Prof. Dr. Bernd Fink
Prof. Dr. Steffen Ruchholtz
Guest Editors

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Keywords

  • periprosthetic joint infection
  • implant-related infection
  • antibiotics
  • spacer
  • diagnosis
  • septic revision arthroplasty
  • irrigation
  • debridement

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Published Papers (2 papers)

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Research

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11 pages, 1184 KiB  
Article
Antibiotic Prophylaxis in Instrumented Lumbar Spine Surgery: Cefazolin Outperforms Clindamycin Regardless of Duration
by Zoltán Nagy, Dóra Szabó, Gergely Agócs, Konrád Szilágyi, Zsanett Rojcsik, József Budai, Zoltán Papp, Csaba Padányi, Loránd Erőss, László Sipos and Péter Banczerowski
Antibiotics 2025, 14(8), 830; https://doi.org/10.3390/antibiotics14080830 - 15 Aug 2025
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Abstract
Background: Surgical site infections (SSIs) are a significant postoperative complication in instrumented lumbar spine surgery, and the selection and duration of appropriate prophylactic antibiotics are key to their prevention. The aim of our study was to evaluate the effectiveness of various prophylactic antibiotics, [...] Read more.
Background: Surgical site infections (SSIs) are a significant postoperative complication in instrumented lumbar spine surgery, and the selection and duration of appropriate prophylactic antibiotics are key to their prevention. The aim of our study was to evaluate the effectiveness of various prophylactic antibiotics, primarily cefazolin and clindamycin, as well as the role of the duration of antibiotic prophylaxis in the development of SSI in instrumented lumbar spine surgeries through retrospective analysis. Methods: We performed a retrospective analysis of data from 915 patients who underwent instrumented lumbar spine surgery between 2016 and 2024 in a university center database. We examined the incidence of SSI according to the type of antibiotic used (cefazolin 1 g or 2 g, or clindamycin 0.6 g) and the duration of prophylaxis (single dose versus 72 h administration). We used the Fisher test and Welch test as a statistical analysis to examine the differences between SSI rates. Results: The incidence of SSI was 11.7%. We measured a significantly lower infection rate with cefazolin compared to clindamycin (OR = 0.45; 95% CI: 0.23–0.94; p = 0.0206), regardless of the duration of antibiotic administration. The 72 h cefazolin prophylaxis showed a slight but statistically insignificant advantage over single dose prophylaxis. The risk of SSI was significantly higher in multi-segment surgeries (p = 0.0005). Conclusions: Cefazolin is a more effective prophylactic antibiotic than clindamycin during instrumented lumbar spine surgery. The duration of antibiotic administration has less influence on the risk of SSI development; therefore, short-term, adequate-dose cefazolin prophylaxis is recommended, which also minimizes the risk of antimicrobial resistance and side effects. Full article
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Review

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18 pages, 333 KiB  
Review
Antibiotic Elution from Cement Spacers and Its Influencing Factors
by Bernd Fink and Kevin D. Tetsworth
Antibiotics 2025, 14(7), 705; https://doi.org/10.3390/antibiotics14070705 - 14 Jul 2025
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Abstract
Antibiotic-loaded cement spacers play a crucial role in two-stage revision arthroplasty of infected total hip and knee prostheses. There is still controversy regarding whether the elution from antibiotic-loaded cement spacers is greater than the MIC for a prolonged time between stages. Therefore, the [...] Read more.
Antibiotic-loaded cement spacers play a crucial role in two-stage revision arthroplasty of infected total hip and knee prostheses. There is still controversy regarding whether the elution from antibiotic-loaded cement spacers is greater than the MIC for a prolonged time between stages. Therefore, the aim of the current review was to determine how long spacers elute antibiotics above the MIC for most causative microorganisms, as well as to evaluate what factors influence that elution. Independent of methodological differences and weaknesses of the studies themselves, several study results indicate that after an early peak of antibiotic release from the spacer in the first 1 to 2 days (followed by a gradual decline), a sufficient release above the MIC for most causative bacteria continues for 6 to 12 weeks. Full article
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