What will move the needle in orthopedic infection control?
By Admin | April 27, 2026
Despite significant advances in orthopedic technology and surgical techniques, infection control in total joint replacements remains an area that has room to grow, surgeons say.
The percentage of infections after total joint surgery are in the single digits, and orthopedic surgeons discussed what can be done to push innovation forward.
Note: Responses were lightly edited for clarity.
Question: How has your approach to infection control in total joint replacements changed in the last five years? What will move the needle in this area in the next five years?
Cory Calendine, MD. Bone and Joint Institute of Tennessee (Franklin): The biggest shift is intellectual rather than technical.
Despite introducing and layering every prophylactic strategy we have such as chlorhexidine, decolonization, cefazolin/ancef (even in PCN allergic patients), numerous lavage options, the rate of PJI has not meaningfully declined. The infection rate is roughly 1% to 2% in primary cases and 4% to 6% in revision cases.
Attention has more recently turned back to the patient and not just their overall health status (such as diabetes and immunocompromised conditions that are known to increase risk) , but also their individual microbiome. Jarad Parvizi, MD, and many others are exploring this concept aggressively, showing that the human knee (once thought to be sterile, zero bacteria) has a distinctive native microbiome, and that certain bacterial signatures make some patients inherently more susceptible to infection. Further, Dr. Parvizi’s group described the “Trojan Horse” hypothesis, in which gut dysbiosis and intestinal permeability may allow bacteria to traverse the gut and reach the artificial implant.
We are likely maximized on the “sterile-field” concept, and hopefully the personalized microbiome concept – testing, stratification, treatment – will finally move the needle on infection rates in the years to come.
Michael Gross, MD. Union Middlesex Orthopedics (Middleton, Conn.): The current approach has evolved toward layered, risk stratified prevention, and the next five years will be...(More)
For more info please read, What will move the needle in orthopedic infection control?, by Becker's Spine Review
