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A modified Delphi consensus on periprosthetic infection in orthopaedic oncology : a report from the Birmingham

Lee Jeys1, Eduardo Botello2, Richard A Boyle3

  • 1Royal Orthopaedic Hospital, Birmingham, UK.

The Bone & Joint Journal
|November 30, 2025
PubMed
Abstract

Insights

Consensus was reached on periprosthetic infection (PJI) management in orthopaedic oncology, including wound care and antibiotic prophylaxis. However, the low quality of evidence necessitates further research for PJI treatment strategies.

Area of Science:

  • Orthopaedic Oncology
  • Infectious Diseases
  • Surgical Innovation

Background:

  • Periprosthetic infection (PJI) poses a significant challenge in orthopaedic oncology, demanding clear management guidelines.
  • Establishing consensus on PJI treatment is crucial for improving patient outcomes and guiding future research.

Purpose of the Study:

  • To achieve expert consensus on key topics concerning periprosthetic infection (PJI) within orthopaedic oncology.
  • To identify critical areas requiring further investigation in PJI research.

Main Methods:

  • A modified Delphi process was employed at the Birmingham Orthopaedic Oncology Meeting (BOOM) in January 2024.
  • 309 international delegates debated 20 consensus statements regarding PJI in orthopaedic oncology.

Main Results:

  • While no unanimous consensus was achieved, 18 statements reached strong consensus on PJI management.
  • Key areas of agreement included infection prophylaxis, management of draining wounds, and surgical revision strategies.
  • Short-duration antibiotic prophylaxis and aggressive wound management were favored; two-stage revision was deemed most reliable.

Conclusions:

  • The study successfully established consensus on critical PJI topics in orthopaedic oncology.
  • A significant finding was the low quality of the underlying evidence, highlighting the need for high-quality research.
  • Recommendations were provided for leaky wound treatment, antibiotic prophylaxis duration, and revision strategy selection.

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