{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:40:22Z","timestamp":1776274822238,"version":"3.50.1"},"reference-count":16,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Moleculight"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,30]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Radical surgical debridement is central to the eradication of prosthetic joint infection. Surgeons are taught that the adequacy of debridement is critical to the success of revision procedures. We aimed to assess the feasibility of using a handheld fluorescent imaging device as an adjunct to tissue debridement in the management of periprosthetic joint infection (PJI) after standard radical debridement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective feasibility trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This was performed at a tertiary prosthetic joint infection unit (The Royal Orthopaedic Hospital, Birmingham, UK), multidisciplinary team (MDT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>10 patients with established PJI managed through a tertiary prosthetic joint infection MDT were recruited between January 2023 and December 2023. All patients underwent standard management, including radical debridement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>After completion of standard radical debridement, the device was used to identify any remaining areas of fluorescence. These areas underwent excision for further intraoperative microbiological and histological sampling to analyse if the represented areas had residual bacterial load.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome<\/jats:title>\n                    <jats:p>To assess whether the fluorescence imaging device is able to detect additional areas of fluorescence which led to positive tissue sampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all cases, the device was able to identify areas of fluorescence, indicating further debridement. In eight cases, an organism was isolated after additional microbiological sampling and culture. In all eight cases, the same isolate was identified with the standard sampling. Additional histological sampling was performed in eight cases and confirmed acute infection in three cases. The remaining five cases demonstrated histologically inflammatory tissue consistent with chronic infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study is encouraging for the feasibility of using this device as an adjunct for debridement in the surgical management of PJIs; further evaluation is underway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-115147","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:39Z","timestamp":1776271239000},"page":"e115147","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Can a fluorescent imaging device (MolecuLight) function as an adjunct to surgical debridement during revision knee arthroplasty for periprosthetic infection in a tertiary centre: a feasibility study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7329-2401","authenticated-orcid":false,"given":"James E","family":"Archer","sequence":"first","affiliation":[{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amirul","family":"Adlan","sequence":"additional","affiliation":[{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaiyapuri","family":"Sumathi","sequence":"additional","affiliation":[{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026041509402217000_16.4.e115147.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2020.12.005"},{"key":"2026041509402217000_16.4.e115147.2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1"},{"key":"2026041509402217000_16.4.e115147.3","doi-asserted-by":"crossref","first-page":"2992","DOI":"10.1007\/s11999-011-2102-9","article-title":"New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society","volume":"469","author":"Parvizi","year":"2011","journal-title":"Clinical Orthopaedics & Related Research"},{"key":"2026041509402217000_16.4.e115147.4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.5194\/jbji-10-101-2025","article-title":"Debridement, antimicrobial therapy, and implant retention (DAIR) as curative strategy for acute periprosthetic hip and knee infections: a position paper of the European Bone\u2009&\u2009Joint Infection Society (EBJIS)","volume":"10","author":"Sigmund","year":"2025","journal-title":"J Bone Joint Infect"},{"key":"2026041509402217000_16.4.e115147.5","doi-asserted-by":"crossref","unstructured":"Serena T . A paradigm shift in chronic wound assessment: incorporating bacterial fluorescence imaging into standard of care. In: Dai T , Wu MX , Popp J , eds. Photonic Diagnosis, Monitoring, Prevention, and Treatment of Infections and Inflammatory Diseases 2020; San Francisco, United States, November 5, 2020:15. doi:10.1117\/12.2550307 Available: https:\/\/www.spiedigitallibrary.org\/conference-proceedings-of-spie\/11223\/2550307\/A-paradigm-shift-in-chronic-wound-assessment--incorporating-bacterial\/10.1117\/12.2550307.full","DOI":"10.1117\/12.2550307"},{"key":"2026041509402217000_16.4.e115147.6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1089\/wound.2020.1272","article-title":"Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial","volume":"10","author":"Le","year":"2021","journal-title":"Adv Wound Care (New Rochelle)"},{"key":"2026041509402217000_16.4.e115147.7","doi-asserted-by":"crossref","first-page":"452","DOI":"10.12968\/jowc.2017.26.8.452","article-title":"Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study","volume":"26","author":"Rennie","year":"2017","journal-title":"J Wound Care"},{"key":"2026041509402217000_16.4.e115147.8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis803"},{"key":"2026041509402217000_16.4.e115147.9","doi-asserted-by":"crossref","DOI":"10.1186\/s42836-023-00170-x","article-title":"Principles of mechanical and chemical debridement with implant retention","volume":"5","author":"Deckey","year":"2023","journal-title":"Arthroplasty"},{"key":"2026041509402217000_16.4.e115147.10","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.cmi.2014.10.024","article-title":"ESCMID guideline for the diagnosis and treatment of biofilm infections 2014","volume":"21 Suppl 1","author":"H\u00f8iby","year":"2015","journal-title":"Clin Microbiol Infect"},{"key":"2026041509402217000_16.4.e115147.11","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1111\/iwj.13345","article-title":"Prospective clinical study on the efficacy of bacterial removal with mechanical debridement in and around chronic leg ulcers assessed with fluorescence imaging","volume":"17","author":"Moelleken","year":"2020","journal-title":"Int Wound J"},{"key":"2026041509402217000_16.4.e115147.12","article-title":"Fluorescence-guided and molecularly-guided debridement: identifying devitalized and infected tissue in orthopaedic trauma","volume":"12361","author":"Elliott","year":"2023","journal-title":"Proc SPIE Int Soc Opt Eng"},{"key":"2026041509402217000_16.4.e115147.13","doi-asserted-by":"crossref","first-page":"3635","DOI":"10.3233\/THC-240479","article-title":"Use of intra-operative fluorescence imaging in periprosthetic joint infection: State of the art and future perspectives","volume":"32","author":"De Mauro","year":"2024","journal-title":"Technol Health Care"},{"key":"2026041509402217000_16.4.e115147.14","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s00259-020-04982-w","article-title":"Image-guided in situ detection of bacterial biofilms in a human prosthetic knee infection model: a feasibility study for clinical diagnosis of prosthetic joint infections","volume":"48","author":"Schoenmakers","year":"2021","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2026041509402217000_16.4.e115147.15","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1302\/2046-3758.121.BJR-2022-0216.R1","article-title":"A radio- and fluorescently labelled tracer for imaging and quantification of bacterial infection on orthopaedic prostheses","volume":"12","author":"Welling","year":"2023","journal-title":"Bone & Joint Research"},{"key":"2026041509402217000_16.4.e115147.16","doi-asserted-by":"crossref","unstructured":"Buckle T , Nelissen R , Pijls B , et al . Hybrid technologies for surgical identification of prosthetic infections. In: Hamblin MR , ed. Handbook of Antimicrobial Photoinactivation [Internet]. Cham: Springer Nature Switzerland, 2025: 1\u201313. Available: https:\/\/doi.org\/10.1007\/978-3-031-55858-0_62-1","DOI":"10.1007\/978-3-031-55858-0_62-1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-115147","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:41Z","timestamp":1776271241000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-115147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,15]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjopen-2025-115147"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-115147","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}