What’s New in Musculoskeletal Infection

Abstract

This Update on musculoskeletal infection presents a review of infection-related articles from 2017, from journals in the National Center for Biotechnology Information (NCBI) databases in the clinical areas of arthroplasty, orthopaedic oncology, orthopaedic trauma, pediatric orthopaedics, and hand surgery. Publications on infectious-disease topics that were relevant to orthopaedics, including antimicrobial prophylaxis (locally applied vancomycin powder), and the Centers for Disease Control and Prevention (CDC) guidelines on surgical site infection (SSI) prevention, published in 2017, were also reviewed. Methods Articles for review were selected by searching all journals in the NCBI databases for the infection-related terms "orthop(a)edic infection," "osteomyelitis," "bone infection," "implant infection," "fracture infection," "septic arthritis," and "biofilm" in combination with terms pertaining to clinical areas of interest: "arthroplasty," "orthop(a)edic oncology," "orthop(a)edic trauma," "fracture," "open fracture," "wound closure," "hand," "finger," "wrist," "child," "children," and "p(a)ediatric(s)." We also searched for "vancomycin powder," "local vancomycin," "intra-wound vancomycin," "intra-operative vancomycin," "intra-site vancomycin," and "topical vancomycin" in all NCBI database journals without associated clinical areaof-interest search terms. Reviewed were English-language papers that were published in 2017 and that reported infection as the topic of focus, the purpose of investigation, or the critical finding, as identified on a review of the title and abstract; we excluded papers that had infection as an incidental finding or were expert opinion. We used our editorial discretion to identify articles that are pertinent and relevant to the readership. A total of 378 articles were identified; 137 are reviewed. The vast majority of the studies were case reports and retrospective reviews, often without controls, that add observations and author experience to our knowledge base but do not provide strong evidence to direct practice. There were few prospective controlled trials or high-quality, large database studies with scientifically valid findings. Antimicrobial Prophylaxis Locally Applied Vancomycin Powder Recent retrospective series have demonstrated associations between the use of vancomycin powder prior to wound closure in spine surgery and reductions in SSI risk; prospective randomized controlled studies are still ongoing. The apparent success of topical vancomycin powder in preventing infection in spine surgery has raised the possibility of its benefit in other surgical fields, including those outside of orthopaedics. Additional studies have focused on the side-effects and impact of vancomycin powder use on the microbial etiology of infection. In the spine literature, 2 retrospective studies noted associations between vancomycin powder use and lower infection risk among surgical patients 1,2. With respect to other orthopaedic disciplines, the use of vancomycin powder was associated with a lower o...

Antimicrobial coatings for orthopaedic implants - Ready for use?

“…The available data, however, indicates that silver-coated implants are beneficial in reducing infection rates in high risk patients with megaendoprostheses in revision or tumor bone surgery [9][10][11]. Other coating surfaces include copper, magnesium, and copper-titanium dioxide [12].…”