Autofluorescence Imaging During Surgery for Orthopedic Infection: A Prospective Feasibility Case Series

Background/Objectives: Intraoperative assessment of infected and nonviable tissue remains challenging in orthopedic surgery. This prospective case series evaluated the technical feasibility of VELscope^® autofluorescence imaging during surgery for orthopedic infection. Methods: Thirteen patients undergoing surgery for hip or knee periprosthetic joint infection or spondylodiscitis were included. Autofluorescence was assessed qualitatively before and after conventional debridement by the operating surgeon, without quantitative thresholds or independent, blinded image assessment. Microbiological and histopathological findings from selected sampled areas were summarized at the patient level. Results: Imaging was performed in all 13 cases without reported device-related complications. Altered autofluorescence was observed at baseline in all cases and was no longer observed after debridement judged macroscopically complete in 12 of 13 cases (92.3%; 95% CI 66.7-98.6). Sampling from areas with altered autofluorescence yielded culture growth in 11 of 13 cases (84.6%; 95% CI 57.8-95.7) and reported active inflammation in 10 of 13 cases (76.9%; 95% CI 49.7-91.8). Conclusions: Intraoperative autofluorescence imaging was technically feasible in this small series. The imaging and laboratory findings are exploratory. Diagnostic accuracy, reproducibility, debridement completeness, and clinical benefit remain to be established.