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Clinical Advances in Orthopedic Infections
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Clinical Advances in Orthopedic Infections

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 3056

Special Issue Editor

Dr. Hyonmin Choe

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
Interests: orthopedic surgery; robot surgery; orthopedic infections; periprosthetic joint infection; surgical site infection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The complexity of orthopedic infections and their profound impact on patient outcomes has been widely recognized over recent decades. We are honored to present this Special Issue, which provides a platform for sharing the knowledge, experiences, and latest advancements from leading experts in the field of orthopedic infections.

Orthopedic infections significantly impair the quality of life of patients and introduce complex challenges in therapy. Thanks to recent research and technological progress, there have been notable advancements in the prevention, diagnosis, and treatment of these infections. This Special Issue explores such advancements, addressing the current challenges and envisioning future possibilities in the management of orthopedic infections. By connecting clinical insights with scientific breakthroughs, our objective is to illuminate the path forward in the management of orthopedic infections.

We anticipate that this Special Issue will act as a pivotal force in enriching our understanding of orthopedic infections and fostering discussions aimed at establishing best practices in patient care.

Dr. Hyonmin Choe
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • orthopedic surgery
  • orthopedic infections
  • periprosthetic joint infection
  • surgical site infection
  • infection management

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Published Papers (4 papers)

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13 pages, 667 KB  
Article
Evaluation of the Diagnostic Accuracy of Serum Albumin and Globulin in Pyogenic Spondylitis
by Hideo Mitsui, Hyonmin Choe, Masashi Shimoda, Hironori Yamane, Yuta Hieda, Koki Abe, Yohei Ito, Hiroyuki Ike, Ken Kumagai, Naomi Kobayashi and Yutaka Inaba
J. Clin. Med. 2025, 14(17), 6001; https://doi.org/10.3390/jcm14176001 - 25 Aug 2025
Abstract
Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most [...] Read more.
Background: Serum markers are commonly used to diagnose bone and joint infections; however, their accuracy for diagnosing pyogenic spondylitis remains unproven. This study aimed to validate the diagnostic accuracy of inflammatory, nutritional, and immunological serum markers for spinal infections and identify the most effective combinations. Methods: The retrospective cohort study analyzed 656 patients who visited the hospital for spinal diseases between 1 January 2004 and 31 March 2021; a total of 76 were diagnosed with pyogenic spondylitis. Blood samples were analyzed for serum albumin (Alb), total protein (TP), globulin (Glb), C-reactive protein (CRP), platelet count, white blood cell count, neutrophil count, lymphocyte count, and monocyte count. Combination markers, including albumin–globulin ratio (AGR), CRP–albumin ratio (CAR), CRP–AGR (CAGR), neutrophil–lymphocyte ratio (NLR), and platelet–lymphocyte ratio (PLR), were also evaluated. Receiver operating characteristic curves were used to determine each marker’s diagnostic performance. Furthermore, multivariate analysis was performed to examine the odds ratios. Results: Patients with pyogenic spondylitis showed significantly different levels in Alb (p < 0.0001), Glb (p < 0.0001), CRP (p < 0.0001), platelet count (p < 0.0001), WBC count (p < 0.0006), neutrophil count (p = 0.0019), lymphocyte count (p = 0.0085), AGR (p < 0.0001), CAR (p < 0.0001), CAGR (p < 0.0001), NLR (p < 0.0001), and PLR (p < 0.0001). CRP (AUC = 0.80) showed good diagnostic accuracy, while combination markers CAR (AUC = 0.82) and CAGR (AUC = 0.83) had the highest areas under the curve (AUC). Multivariate analysis indicated that decreased age and the presence of comorbidities (including chronic kidney disease, chronic liver disease, malignancy, or diabetes), were independent predictors of early pyogenic spondylitis (OR_age = 0.93, OR_comorbidities = 16.98, p_age = 0.0005, and p_comorbidities = 0.0001). In patients with low-inflammatory pyogenic spondylitis, significant differences were observed in TP (p = 0.0293), Glb (p = 0.0012), CRP (p = 0.0023), platelet count (p = 0.0108), AGR (p = 0.0044), CAR (p = 0.0006), CAGR (p = 0.0004), PLR (p = 0.0192), and NLR (p = 0.0027), with CAGR showing the highest AUC (AUC = 0.70) among them. Conclusions: Serum combination markers (AGR, CAGR, CAR, PLR, and NLR) showed diagnostic value for pyogenic spondylitis, with CAGR achieving the highest accuracy. In low-inflammatory pyogenic spondylitis patients (CRP ≤ 1.0 mg/dL), these markers may aid diagnosis. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopedic Infections)
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10 pages, 1209 KB  
Article
Feasibility and Potential Clinical Ramifications of Using Bacteriophage Therapy for S. aureus Necrotizing Fasciitis
by James B. Doub, Dakarai Dunbar, Sara Jain, Maggie Manchester, Lila Berle, Janvi Madhiwala, Bradley Anderson, Riva Malick, Max Jacobs and Kenneth L. Urish
J. Clin. Med. 2025, 14(16), 5609; https://doi.org/10.3390/jcm14165609 - 8 Aug 2025
Viewed by 298
Abstract
Background: Staphylococcus aureus necrotizing fasciitis is a life-threatening infection requiring aggressive surgical and medical management. Despite these interventions, tremendous morbidity and mortality occur. Thus, novel agents are needed to reduce these negative outcomes. Consequently, the aims of this translational study were to [...] Read more.
Background: Staphylococcus aureus necrotizing fasciitis is a life-threatening infection requiring aggressive surgical and medical management. Despite these interventions, tremendous morbidity and mortality occur. Thus, novel agents are needed to reduce these negative outcomes. Consequently, the aims of this translational study were to evaluate the feasibility of using bacteriophages and the potential clinical ramifications of using bacteriophages in treatment of S. aureus necrotizing fasciitis. Methods: Necrotizing fasciitis clinical isolates (n = 6) were tested against different Staphylococcal bacteriophages (n = 4) to assess for activity. After exposure to bacteriophages that had growth inhibition for more than 16 h, the ability of S. aureus to change phenotypic expression of numerous enzymes was evaluated, and the ability to reduce bacterial virulence was measured with the Caenorhabditis elegans assay. Results: Staphylococcal myoviridae bacteriophages were able to lyse most clinical isolates (83%). Interestingly, after exposure to myoviridae bacteriophages, S. aureus isolates had no expression of hemolysin, secreted coagulase, or lecthinase, or the ability to ferment mannitol. These same bacteriophages also caused statistically significant decreases in bacterial virulence (p < 0.05). Neither findings were observed for bacteriophages of the podoviridae family. Conclusions: To use bacteriophages for S. aureus necrotizing fasciitis, cocktails of Staphylococcal myoviridae are likely needed to allow for broad host ranges, mitigating the need for in vitro sensitivity testing. Moreover, Staphylococcal myoviridae have the potential to reduce specific enzyme expression and global virulence of residual S. aureus. Thus, bacteriophages may aid in reducing necrotizing fasciitis morbidity by not only lysing S. aureus but also by reducing S. aureus virulence. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopedic Infections)
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12 pages, 2139 KB  
Article
Biofilm Growth on Different Materials Used in Contemporary Femoral Head Prosthesis: An In Vitro Study
by Yonggyun Moon, Jaeyoung Hong, Sookyung Choi, Hyoungtae Kim, Hong Moon Sohn and Suenghwan Jo
J. Clin. Med. 2025, 14(5), 1722; https://doi.org/10.3390/jcm14051722 - 4 Mar 2025
Viewed by 923
Abstract
Background/Objectives: Periprosthetic joint infection (PJI) primarily results from bacterial biofilms adhering to prosthetic surfaces, making treatment challenging without prosthesis removal. This in vitro study aims to investigate whether the materials used in contemporary femoral head prosthesis influences bacterial biofilm development. Methods: Femoral [...] Read more.
Background/Objectives: Periprosthetic joint infection (PJI) primarily results from bacterial biofilms adhering to prosthetic surfaces, making treatment challenging without prosthesis removal. This in vitro study aims to investigate whether the materials used in contemporary femoral head prosthesis influences bacterial biofilm development. Methods: Femoral head prostheses made of three different materials—cobalt–chrome, oxinium, and ceramic—were inoculated with either Staphylococcus aureus or Pseudomonas aeruginosa in separate experiments, with each pathogen tested independently. The samples were cultured under shaking conditions at 37 °C for 96 h to promote biofilm formation. Scanning electron microscopy (SEM) was used to confirm the presence of biofilms, and adherent biofilms were quantified by counting colony-forming units (CFUs) after sonication. Additionally, crystal violet staining was performed to assess biofilm distribution on the femoral head surfaces. Statistical analyses compared CFU counts across the different materials. Results: The mean CFU counts for S. aureus were 7.6 × 105 ± 9.7 × 104 for cobalt–chrome, 6.9 × 105 ± 3.6 × 105 for oxinium, and 1.1 × 106 ± 3.0 × 105 for ceramic femoral head prostheses. For P. aeruginosa, the CFU counts were 2.3 × 106 ± 7.2 × 105, 3.7 × 106 ± 2.5 × 106, and 2.2 × 106 ± 8.9 × 105, respectively. Regardless of the bacterial strain, differences among the three materials were within one log range, and no statistical significance was observed. While biofilms were confirmed using SEM, limited adherence was observed on the bearing surface, with the biofilm predominantly localized in the taper hole. Conclusions: The findings suggest that the material used in contemporary femoral head prostheses has minimal impact on bacterial biofilm formation. Surgeons’ choice of femoral head prosthesis material should base their material selection on factors other than PJI prevention. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopedic Infections)
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10 pages, 785 KB  
Case Report
Neisseria sicca Vertebral Osteomyelitis: A Case Report and Literature Review
by Natasha Priya Dyal, Robert Orenstein and Sandhya Rani Nagarakanti
J. Clin. Med. 2024, 13(23), 7241; https://doi.org/10.3390/jcm13237241 - 28 Nov 2024
Viewed by 1223
Abstract
Background: Culture-negative vertebral osteomyelitis presents a significant diagnostic challenge. Neisseria sicca (N. sicca) is a typically benign commensal organism of the upper respiratory tract that rarely causes invasive infections, warranting cautious interpretation if isolated in a single positive culture. This [...] Read more.
Background: Culture-negative vertebral osteomyelitis presents a significant diagnostic challenge. Neisseria sicca (N. sicca) is a typically benign commensal organism of the upper respiratory tract that rarely causes invasive infections, warranting cautious interpretation if isolated in a single positive culture. This case study details a 62-year-old male diagnosed with vertebral osteomyelitis caused by N. sicca, examining diagnostic challenges, treatment, and outcomes. Methods: We conducted a comprehensive search on MEDLINE using the keywords “Neisseria sicca”, “osteomyelitis”, and “diskitis”. An additional search excluding N. gonorrhea and N. meningitidis was also performed, revealing a total of four cases of N. sicca osteomyelitis in the literature. Results: A 62-year-old male with a history of hypertension, type 2 diabetes, atrial fibrillation, and previous L5-S1 spinal fusion presented with fever and back pain in May 2023. Initial imaging revealed T8-T9 vertebral osteomyelitis. Despite a six-week course of IV daptomycin, his symptoms worsened, prompting further evaluation. A CT-guided biopsy with comprehensive testing, including histopathology and microbial cultures, initially identified N. sicca. Due to its rarity, additional biopsies were conducted, confirming the infection. IV ceftriaxone was initiated, leading to significant pain improvement, and a subsequent MRI showed near resolution. The patient transitioned to oral cefuroxime, with follow-up confirming complete infection resolution by December 2023. Conclusions: This case underscores the importance of a structured diagnostic approach in culture-negative vertebral osteomyelitis to differentiate between commensal contamination and true infection. Repeated positive cultures of N. sicca from a sterile site confirmed its role as the causative agent. Early identification and targeted antibiotic therapy are critical to improving outcomes in rare cases of N. sicca vertebral osteomyelitis. Full article
(This article belongs to the Special Issue Clinical Advances in Orthopedic Infections)
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