At The Ohio State University Wexner Medical Center, our nationally recognized team of musculoskeletal specialists help people with disabling, chronic, sometimes unexplained pain caused by two types of musculoskeletal infection: infection of the bone and infection of joint replacements. It’s important to get timely treatment for these types of infection.

One of only a few programs in the country dedicated to the diagnosis and treatment of bone- and tissue-damaging infection, Ohio State’s team of orthopedic surgeons, infectious diseases specialists, radiologists, researchers, laboratory technicians and nurses specializes in helping you manage musculoskeletal infection and, when possible, eliminate it.

What you can expect

Diagnosis of musculoskeletal infection

Our musculoskeletal infection physicians will perform a comprehensive physical examination on you and talk with you about your condition, symptoms, medical history and any prior treatments.

We may order diagnostic tests to help determine the cause of the infection. These tests help to see possible abnormalities in bones, joints and soft tissues: X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scan.

We might also order a joint fluid analysis, a test that uses a needle to withdraw a sample of your joint fluid for examination. The fluid in your joints can tell us the exact problem causing your pain and inflammation.

We may also perform blood work, including a complete blood count to measure red and white blood cells and hemoglobin, and an erythrocyte sedimentation rate test and C-reactive protein test to check for inflammation in the body.

Treatment options for musculoskeletal infection

Most patients come to us by referral because they’ve experienced chronic infection lasting days, months or even years that can’t be successfully treated by their primary care or other physician.

Your Ohio State doctor will discuss treatment recommendations with you, which may include aggressive antibiotic treatment and surgical management, such as:

Explants of hardware. This is the removal of an implanted device. This could include pins, plates or screws from a previous fracture or the joint implant itself, if the infection is related to knee or hip joint replacement. When an implant is removed entirely, our doctor’s first concern is treating or eliminating the infection before determining if you’re a candidate for re-implantation.
Mobile spacers. To treat the infection, we might surgically insert an antibiotic-filled cement spacer. The spacer is a medical-grade material that’s mixed with antibiotics and then molded to the joint. It likely will stay in place for two to six months, during which time we’ll closely monitor you. Once the infection is gone, a surgeon will remove the spacer. If re-implantation is an option, joint replacement surgery will happen next. Depending on your overall condition, you may undergo re-implantation quickly. Some patients are never re-implanted, due to the nature and level of infection. Your doctor will discuss options and explain personalized treatment plans in detail.
Static spacers. If your infection is very serious, it may take longer to treat it. For some infections, there’s a possibility that it may never be completely cleared up. Such serious infections may require surgically implanting a static spacer, which is essentially a rod with cement and antibiotic packed around the space where the joint implant was previously located. This spacer can remain in place for two or even three years until the infection is gone. At that time, re-implantation could be an option. Some patients may never be eligible for re-implantation. If your condition requires advanced reconstruction and additional work with the bone, we may refer you to one of our adult reconstruction specialists for joint replacement.
Operative irrigation and debridement. This is used when there’s a bone infection (not necessarily related to a joint replacement). During this procedure, the physician removes the infected bone area and cleans it out. As part of the infection management strategy, we will pack the area with a medical-grade, synthetic, dissolvable “plaster” that’s been mixed with antibiotics. Like mobile and static spacers, this plaster is designed to help eliminate infection. Finally, as part of our ongoing treatment of musculoskeletal infection, we continually monitor your progress over time. You’ll see your clinical care team and continue to undergo imaging and laboratory testing as a measurement of your progress.

Why choose Ohio State for musculoskeletal infection?

Multidisciplinary care: Our fellowship-trained orthopedic surgeons work in collaboration with infectious diseases specialists, and with our adult reconstruction surgical team when necessary, to provide patients with the best possible outcome.

Surgical expertise: We’re one of only a few programs in the country dedicated to the diagnosis and treatment of bone- and tissue-damaging infection. Many of our patients are referred to us by physicians from around Ohio and the surrounding states.

Orthopedic excellence: U.S. News & World Report consistently names our Orthopaedic program a high-performing specialty in its rankings of Best Hospitals.

Research: Our surgical team benefits from the work being done by Ohio State scientists and researchers. One example is the study of biofilm development, which involves learning how bacteria attach to medical implants. Another project involves testing how certain immunosuppressive-type chemicals can be used to coat medical implants and discourage bacterial attachment, reducing the possibility of implant-related infection.

Distinct Count of CSN_ID	FY
CPT - Procedures	FY2017	FY2018	FY2019	FY2020	FY2021	Total
11981 - PR INSERTION DRUG IMPLANT DEVICE	56	45	80	110	132	423
11983 - PR REMOVAL W/ REINSERT DRUG IMPLANT DEVICE	15	7	15	28	58	123
26992 - PR INCIS/DRAIN PELVIS/HIP, OPEN BONE	10	8	16	12	32	78
27091 - PR REMOVAL OF HIP PROSTHESIS, COMPLEX	10	13	10	25	27	85
27134 - PR REVISE TOTAL HIP REPLACEMENT	44	37	45	49	76	251
27138 - PR REVISE FEM PART OFTOTAL HIP	6	3	13	10	15	47
27487 - PR REVISE KNEE JOINT REPLACE, ALL PARTS	30	37	40	61	98	266
Grand Total	171	150	219	295	438	1273

Brooks, J.R., Dusane, D.H., Moore, K., Gupta, T., Delury, C., Aiken, S.S., Laycock, P.A., Sullivan, A.C., Granger, J.F., Dipane, M.V., McPherson, E.J., Stoodley, P. 2021. Pseudomonas aeruginosa Biofilm Killing Beyond The Spacer By Antibiotic Loaded Calcium Sulfate Beads: An In Vitro Study. JBJI. J Bone Joint Infect. 2021;6:119-129.

Moore K, Wilson-van Os R, Dusane, DH, Brooks JR, Delury C, Aiken SS, Laycock PA, Sullivan AC, Granger JF, Dipane MV, McPherson EJ, Stoodley P. 2021. Elution Kinetics from Antibiotic-Loaded Calcium Sulfate Beads, Antibiotic-Loaded Polymethacrylate Spacers, and a Powdered Antibiotic Bolus for Surgical Site Infections in a novel In Vitro Draining Knee Model. Antibiotics. 2021 Mar 8;10(3):270. doi: 10.3390/antibiotics10030270. PMID: 33800299; PMCID: PMC8000420.

Jiang N, Dusane DH, Brooks JR, Delury CP, Aiken SA, Laycock PA, Stoodley P. Antibiotic loaded β-tricalcium phosphate/calcium sulfate for antimicrobial potency, prevention and killing efficacy of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms. Sci Rep. 2021 Jan 14;11(1):1446.

Lansing, S.S., Moley, J.P., McGrath, M.S., Stoodley, P., Chaudharic, A., Quatman, C.E. 2020. High number of door openings increases the bacterial load of the operating room. Surgical Infections. SUR-2020-361 doi: 10.1089/sur.2020.361.

Linklater DP, Baulin VA, Le Guével X, Fleury JB, Hanssen E, Nguyen THP, Juodkazis S, Bryant G, Crawford RJ, Stoodley P, Ivanova EP. 2020. Antibacterial Action of Nanoparticles by Lethal Stretching of Bacterial Cell Membranes. Adv Mater. 2(52):e2005679. doi: 10.1002/adma.202005679. PMID: 33179362.

Staats, A.*, Li, D.*, Sullivan, A., Stoodley, P. 2020. Biofilm Formation in Periprosthetic Joint Infections. Annals of Joint.
http://dx.doi.org/10.21037/aoj-20-85.

Stoodley, P., Brooks, J., Peters, C.W., Jiang, N., Delury, C., Laycock, P., Aiken, S., Dusane, D.H. 2020. Prevention and Killing Efficacy of Carbapenem Resistant Enterobacteriaceae (CRE) and Vancomycin Resistant Enterococci (VRE) Biofilms by Antibiotic-Loaded Calcium Sulfate Beads. Materials.13(15):3258. doi.org/10.3390/ma13153258.

Gupta, T.T., Gupta, N.K., Pestrak, M.J., Dusane, D.H., Harro, J.M., Horswill, A.R., Stoodley, P. 2020. Investigation of Staphylococcus aureus Aggregates on Orthopedic Materials under Varying Shear Stress App. Environ. Microbiol. 86 (19) e01234-20; PMID: 32709721. *Selected for AEM “Spotlights”.

Macias-Valcayo A.*, Staats, A.*, Aguilera-Correa, J.J., Brooks, J., Gupta, T., Dusane, D.&, Stoodley, P.&, Esteban, J. 2020. Synovial fluid mediated aggregation of clinical strains of four enterobacterial species. Adv Exp Med Biol. 2020 Aug 15. PMID: 32797406.
* Equal first author. & Joint corresponding.

Locke, L., Shankaran, K., Gong, L., Stoodley, P., Vozar, S.L., Cole, S.L., Tweedle, M.F. and Wozniak, D.J., 2020. Evaluation of peptide-based probes towards in vivo diagnostic imaging of bacterial biofilm-associated infections. ACS Infectious Diseases. 6(8):2086-2098. PMID: 32603591. doi: 10.1021/acsinfecdis.0c00125.

Heald, R., Bennett, M., Subramaniam, V.V., Dusane, D., Lochab, V., Sundaram, P.M., Salyer, S., West, J.D., Stoodley, P. and Prakash, S. 2020. Printed Electroceutical Dressings for the Inhibition of Biofilms and Treatment of Chronic Wounds. J. Microelectromechanical Systems. 29(5):918-923, Oct. 2020, doi: 10.1109/JMEMS.2020.2999260.

Sindeldecker, D., Moore, K., LI, A., Wozniak, D.J., Anderson, M., Dusane, D.H., Stoodley, P. 2020. Novel Aminoglycoside Tolerant "Phoenix" Colony Variants of Pseudomonas aeruginosa. Antimicrob Agents Chemother. Aug 20;64(9):e00623-20. PMID: 32540981. IF2018 = 4.615.

This paper was featured on the ASM April 9th 2021 “This Week in Microbiology Podcast - 239: The Phoenix of Bacteria”. https://overcast.fm/+HDTjMtCQ. This podcast discusses Devin Sindledecker's paper from the Stoodley lab team which identifies a novel aminoglycoside antibiotic tolerant type of cell which hides out in Pseudomonas aeruginosa biofilms - a pathogen which causes many types of chronic biofilm infections including those of artificial hips and knees.

Lochab, V., Jones, T.H., Dusane, D.H., Peters, C.W., Stoodley, P., Wozniak, D.J., Subramaniam, V.V., Prakash, S. 2020. Ultrastructure imaging of Pseudomonas aeruginosa lawn biofilms and eradication of the tobramycin-resistant variants under in vitro electroceutical treatment. Sci Rep. 10(1):1-12. PMID: 32555250.

Linklater, D.P., Vladimir A. Baulin, V.A., Juodkazis, S., Crawford, R.J., Stoodley, P., Ivanova. E.P. 2021. Mechano-bactericidal actions of nanostructured surfaces. Nat. Revs. Microbiol. Nat Rev Microbiol. 19(1):8-22. IF = 31.851.

Pestrak, M.J., Gupta,T.T., Dusane, D.H., Guzior, D.V., Staats, A., Harro, J., Horswill, A.R., Stoodley, P. 2020. Investigation of synovial fluid induced Staphylococcus aureus aggregate development and its impact on surface attachment and biofilm formation. PLoSOne. 17;15(4):e0231791. PMID: 32407362.

Xu, Y., Dhaouadi, Y., Stoodley, P. and Ren, D., 2020. Sensing the unreachable: challenges and opportunities in biofilm detection. Current opinion in biotechnology, 64, pp.79-84.

Ibrahim MS, Ryan S, Seyler T, Arnold WV, Stoodley P, Haddad F. 2020. Infection in Arthroplasty: The Basic Science of Bacterial Biofilms in Its Pathogenesis, Diagnosis, Treatment, and Prevention. Instr Course Lect. 2020;69:229-242. PMID: 32017730.

Francolini, I., Hall-Stoodley, L., Stoodley, P. 2020. “Biofilms, biomaterials, and device-related infections”. In: Biomaterials Science Fourth Edition: An Introduction to Materials in Medicine. Eds. Wagner, W., Sakiyama-Elbert, S., Zhang, G., Yaszemski, M. Elsevier Academic Press, 4th March 2020 ISBN: 9780128161371.

Schwarzer, S., James, G., Goeres, D., Bjarnsholt, T., Vickery, K., Percival, S., Stoodley, P., Schultz, G., Jensen, S., Malone, M. 2020. The efficacy of topical agents used in wounds for managing chronic biofilm infections: a systematic review. Journal of Infection, 80(3), pp.261-270.

Gloag, E.S., Fabbri, S., Wozniak, D.J., Stoodley, P. 2020. Biofilm mechanics: implications in infection and survival. Biofilm, 2, 100017.

Dusane, D.H.,* Brooks, J.R., Sindeldecker, D., Peters, C.W., Li, A., Farrar, N.R., Diamond, S.M., Knecht, C.S., Plaut, R.D., Delury, C., Aiken, S.S., Laycock, P.A., Sullivan, A., Granger, J.F., Stoodley, P. 2019. Complete Killing of Agar Lawn Biofilms by Systematic Spacing of Antibiotic-Loaded Calcium Sulfate Beads. Materials. 12(24), 4052.PMID: 31817373.
https://doi.org/10.3390/ma12244052.

Saeed, K., Sendi, P., Arnold, W.V., Bauer, T.W., Coraça-Huber, D.C., Chen, A.F., Choe, H., Daiss, J.L., Ghert, M., Hickok, N., Nishitani, K., Springer, B.D., Stoodley, P., Sculco, T.P., Brause, B., Parvizi, J., McLaren, A.C., Schwarz, E.M. 2020. Bacterial Toxins in Musculoskeletal infections. J. Ortho. Res. Feb;39(2):240-250.

Schwarz, E.M., McLaren, A.C., Sculco, T.P., Brause, B., Bostrom, M., Kates, S.L., Parvizi, J., Alt, V., Arnold, W.V., Carli, A., Chen, A.F., Choe, H., Coraça-Hube, D.C., Cross, M., Ghert, M., Hickok N., Jennings, J.A., Joshi, M., Metsemakers W-J., Ninomiya, M., Nishitani K., Oh, I., Padgett, D., Ricciardi B., Saeed, K., S., Sendi, P., Springer, B., Stoodley, P., Wenke, J.C. Hospital for Special Surgery 2019 Biofilm Symposium Workgroup. 2020. Adjuvant Antibiotic-Loaded Bone Cement: Concerns with Current Use and Research to Make it Work. J. Ortho. Res. Jan 30;10.1002/jor.24616. PMID: 31997412.

Prades, L., Fabbri, S., Dorado, A.D., Gamisans, X., Stoodley, P*. and Picioreanu, C., 2020. Computational and experimental investigation of biofilm disruption dynamics induced by high velocity gas jet impingement. mBio. 11(1): e02813-19.
*Corresponding.

Musculoskeletal Infection

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How we treat Orthopedic Infections

Anne Sullivan, MD, is a general orthopedic surgeon, she treats a wide range of bone and joint conditions with a sub specialization in orthopedic infections. Here, she discusses how infections might stem from bones, joints or hardware from a previous procedure and how Ohio State collaborates to bring the best and most convenient care to our patients.

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Caring for Osteomyelitis

Infections involving a bone are known as osteomyelitis. They are frequently treated with antibiotics, but surgery may be necessary. Here, Anne Sullivan, MD, a general orthopedic surgeon at The Ohio State University Wexner Medical Center, explains how we care for patients with these types of complex infections.

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Caring for Osteomyelitis

If you need mobility help

If you need home medical equipment, such as a walker or a wheelchair, it’s easy to obtain quickly through Ohio State Home Medical Equipment (OSHME), a joint venture between Ohio State Health Inc. and DASCO Home Medical Equipment. OSHME has staff and supplies on hand for patients of The Ohio State University Wexner Medical Center. To learn more about available equipment, place an order or talk to an equipment specialist, visit godasco.com.