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Open research questions in Orthopedic Infections and Treatments

37 unresolved questions extracted from the limitations and future-work sections of 362 Orthopedic Infections and Treatments papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • However, we do not have details on these cases, as this study included only 44% of sonica- tion of complete hip or knee implants: the remaining cases included, in particular, osteosynthesis hardware, bone sequestra, and cement, for which the utility of the technique is very poorly documented.

    Contribution of sonication to the microbiology diagnosis of periprosthetic joint infection: Retrospective study of real-world data · 2026 · DOI

  • design does not possess the methodological rigour of a systematic review and lacks meta-analysis; there is large heterogeneity among the available studies in terms of biomaterial composition, techniques used for drug loading, release kinetics, the antimicrobial agents used and outcome measures; and many of the technologies discussed are still in early translational stages, and highquality clinical evidence specific to OMFS is limited. Finally, several advanced drug delivery platforms still have limited long-term safety, cost-effectiveness, and regulatory data. More systematic reviews, randomised controlled trials, and multicentre translational studies are necessary to determine comparative effectiveness and establish standardised clinical protocols for antimicrobial delivery technologies in oral and maxillofacial surgery.

    Advanced Drug Delivery Strategies for Prevention and Management of Surgical Site Infections in Oral and Maxillofacial Surgery: Current Evidence, Emerging Technologies, and Future Perspectives · 2026 · DOI

  • Despite substantial progress, advanced antimicrobial delivery systems into routine OMFS practice remain highly debated. Evidence of sterility, biocompatibility, release reproducibility, manufacturing scalability, longterm safety and clinical effectiveness is required for drug- [2,19,35]. Many and-device combination products nanoparticle, coating and smart biomaterial systems are still rigorous the preclinical stage. Therefore, randomised trials, standardised reporting of outcomes and cost-effectiveness analysis are required before general use [22, 33, 35]. Artificial intelligence is becoming a useful tool for the design and optimisation of drug delivery analyse patient systems. Machine demographics, complexity, laboratory values, microbiological profiles, and imaging in features individualised. Computational modelling can also be applied to optimise nanoparticle composition, drug loading capacity, release kinetics and scaffold architecture, thereby speeding up the development of next-generation therapeutic platforms. The future of SSI prevention in OMFS will probably that combine rely on multifunctional biomaterials antimicrobial and activity, intelligent drug release into one platform. Drug-eluting implants, therapeutics targeting biofilms, smart hydrogels, 3D-printed scaffolds, antimicrobial peptides, and combination platforms delivering antimicrobial, antiregenerative immunomodulatory, and inflammatory, infection agents may revolutionise perioperative management [22, 24, 33, 42-46]. Taken together, advances in nanotechnology, biomaterials engineering, artificial intelligence, and regenerative medicine offer the promise of moving SSI prevention from a reactive to a the risk of SSI and help regenerative potential perioperative to predict planning predictive, localised, and precision-based approach. Table 3 denotes the emerging technologies and translational priorities.

    Advanced Drug Delivery Strategies for Prevention and Management of Surgical Site Infections in Oral and Maxillofacial Surgery: Current Evidence, Emerging Technologies, and Future Perspectives · 2026 · DOI

  • • We demonstrated that intra-articular DI combined with systemic vancomycin is an effective and safe treatment for - PJI in a rat model, outperforming vancomycin monother apy. This provides experimental evidence for its further clinical application. • A limitation of this study is that debridement and revision surgery – common clinical interventions – were not included in the regimen, which may explain why complete eradication of pathogens and biofilm was not achieved. • Furthermore, this study in nature and requires further experimentation to clarify the clinical translational potential of DI in treating PJI.

    Effects of intra-articular injection of dimethyl itaconate combined with systemic vancomycin on periprosthetic joint infection in rats · 2026 · DOI

  • This can be made challenging when the history and presentation are suggestive of SA but joint aspirate analysis is inconclusive or culture data are not available in a timely fashion.

    Can we identify which patients are likely to have septic arthritis with borderline synovial fluid cell counts? · 2026 · DOI

  • Introduction The optimal timing for reimplantation following two-stage exchange for chronic periprosthetic joint infection (PJI) remains elusive and subjective.

    THE CRP/ALBUMIN RATIO AS A PROGNOSTIC INDICATOR TO GUIDE THE TIMING OF REIMPLANTATION IN PROSTHETIC JOINT INFECTION: A MULTICENTRE ANALYSIS · 2026 · DOI

  • Although povidone-iodine (PVP-I) is widely used as an intraoperative antiseptic, its effectiveness against biofilms at different stages of development remains unclear.

    Bactericidal effects of diluted povidone-iodine on Staphylococcus epidermidis at different stages of biofilm formation on titanium surfaces · 2026 · DOI

  • The reasons for this observation remain unclear and cannot be determined from the available data. Nevertheless, this observation highlights the potential for regional variation in the microbiology of SA and warrants further investigation in larger studies specifically examining risk factors and pathogen distribution among intravenous drug users.

    Clinical and Microbiological Features of Adult Patients With Septic Arthritis of Native Joints at Sultan Qaboos University Hospital: A 10-Year Retrospective Study · 2026 · DOI

  • The currently widespread opinion about the contraindication of extracorporeal shock wave therapy in the presence of infection in the body, due to the risk of exacerbation of the inflammatory process, the likelihood of bacteremia, sepsis, and foci of secondary infection, has not been confirmed in the experimental studies in vivo.

    Extracorporeal shock wave therapy: options in chronic osteomyelitis (literature review) · 2024 · DOI

  • Thus, the present article aims to address this gap in the literature and present conclusive evidence about the gender-based comparative evaluation of the microbial load of Aggregatibacter actinomycetemcomitans, one of the potential periodontopathogens for the disease progression, present in anterior versus posterior implant sites.

    Gender-based predilection for the microbial load of Aggregatibacter actinomycetemcomitans present in anterior versus posterior implant sites · 2022 · DOI

  • Treatment effi- cacy can only be evaluated longitudinally, and it remains unclear whether pathogen profiles will change increasingly targeted antibiotic therapy.

    Optimizing pathogen detection in skull base osteomyelitis: a comparative analysis of swab versus biopsy sampling · 2026 · DOI

  • Case Report: First report of chronic osteomyelitis caused by Staphylo- coccus hyicus: a zoonotic pathogen with underreported clinical signifi- cance.

    First report of acute septic arthritis caused by zoonotic staphylococcus hyicus in a 2-year-old boy. A case report and literature review · 2026 · DOI

  • Although limited by the small number of events, this study establishes the first institutional baseline for acute knee PJI in our center.

    Acute Periprosthetic Joint Infection After Primary Total Knee Arthroplasty: Experience From a Secondary Public Hospital in Northern Mexico · 2026 · DOI

  • However, sonication protocols vary widely across studies, including differences in containers, fluids, ultrasound settings, processing steps, and colony-forming unit thresholds, with inconsistent reporting further compounding the issue.

    Currently applied sonication protocols for the detection of implant-associated infections in orthopaedics: a scoping review · 2026 · DOI

  • Background Limb necrosis in pediatric septic shock may serve as a persistent source of deep infection, but its role in hematogenous dissemination is underrecognized.

    Case Report: Progressive limb necrosis as a portal to multifocal osteomyelitis in pediatric septic shock: a tissue-oriented management paradigm · 2026 · DOI

  • The analysis of the presented data indicates the need for further study of the mechanism of extracorporeal shock wave effect on chronic osteomyelitis, possible complications associated with the use of the method, as well as its approbation in the clinic.

    Extracorporeal shock wave therapy: options in chronic osteomyelitis (literature review) · 2024 · DOI

  • Nonsurgical therapy, with or without the use of antimicrobials, will occasionally resolve peri-implantitis, but for the majority of advanced lesions this approach is insufficient and surgery is indicated.

    Treatment of pathologic peri‐implant pockets · 2017 · DOI

  • CONCLUSION: Although a comparison of the published results was limited because of the inhomogeneity of the studies, it is clear that the microbiologic profile of peri-implantitis consists of aggressive and resistant microorganisms and is distinct from that of periodontitis.

    The Microbiologic Profile Associated with Peri-Implantitis in Humans: A Systematic Review · 2015 · DOI

  • There is a large amount of published literature available for both povidone and cadexomer iodine although the results are often conflicting due to the large array of different preparations used and different study types employed.

    The role of povidone and cadexomer iodine in the management of acute and chronic wounds · 2013 · DOI

  • Within the limitations of this study, it can be speculated that the resistance of antibiotics may compromise the routine prophylaxis against infective endocarditis.

    Bacteremia following dental implant surgery: Preliminary results · 2012 · DOI

  • These data indicate significant bacterial contamination of bone collected in osseous coagulum traps and justify further research into methods for eliminating that contamination.

    Osseous Coagulum Collected in Bone Traps: Potential for Bacterial Contamination and Methods for Decontamination · 2007 · DOI

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37 open questions have been extracted from the limitations and future-work passages of 362 Orthopedic Infections and Treatments papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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