Editorial Comment (2005)

Device-related infection remains one of the most common and most feared complications of orthopaedic procedures by both patients and their treating physicians. This symposium is the result of the Association of Bone and Joint Surgeons’ annually sponsored workshop, which was held in November 2004. Sadly, and shortly after this workshop, an active workshop participant and one of the pioneers in the field of musculoskeletal infection, Carl L. Nelson, MD, died unexpectedly in Little Rock, Arkansas. He was a friend and mentor to many of the workshop participants. His fiery personality and intense passion for this area of orthopedics will be sorely missed. The intent of this workshop was to collect a diverse group of clinicians and basic research investigators to discuss the current status and future directions required in several distinct areas regarding device-related infection. Specific areas of discussion included pathogenesis, prevention, diagnosis, drug-resistance, and treatment strategies. In the tradition of previous workshops, participants were asked to formulate their presentations and group interactions within the framework of three questions: (1) Where are we now? (2) Where do we need to go? and (3) How do we get there? One of the most compelling revelations to the workshop participants was how much information is available, yet remains unshared, within the various disciplines represented. The increased use of sophisticated genetic detection technologies, complex imaging techniques, and unique prevention strategies are exciting and viable areas of investigation that are fertile for continued research efforts. These technologies still require considerable effort to be translated effectively from the laboratory into the clinical setting. Likewise, the use of locally administered high-dosage antimicrobials, which has improved the treatment success of these device-related infections, seems poised to benefit from these and other emerging technologies. The workshop breakout sessions focused on establishing recommendations for the use of currently available diagnostic methods and how newer techniques should be adopted as they become more readily available. Additionally, the age-old question of how to exactly define infection and how that definition will change with the introduction of emerging technologies was discussed. The expanding knowledge of biofilm infection has considerable implications for many treatment approaches such as the use of locally delivered antimicrobials. Alternative treatment strategies that can potentially augment the efficacy of these antimicrobials are required. Over the past decade, the scope and magnitude of information has become exponential in nature and it was a unanimous conclusion of the workshop participants that substantial multidisciplinary investigation still is required for this important area of medicine. We would like to thank all of the participants of this workshop sincerely for their valuable time, expertise, and enthusiasm. In particular, the Association of Bone and Joint Surgeons should be congratulated for its foresight and continued support of this unique educational forum. We hope that readers will benefit from the product of this unique workshop contained within the following collection of manuscripts.