{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:55:12Z","timestamp":1790283312727,"version":"4.1.0"},"reference-count":89,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Periprosthetic joint infections (PJIs) of the hip and knee are one of the most severe complications in arthroplasty, often requiring prolonged antibiotic therapy and multiple revision surgeries. The increasing prevalence of multidrug-resistant organisms and biofilm-associated PJIs has renewed interest in bacteriophage therapy as a targeted, adjunctive treatment option in refractory cases. This investigation systematically reviews and discusses the current evidence regarding the application, outcomes, and safety profile of bacteriophage therapy in the management of PJIs. Methods: This systematic review was conducted in accordance with the 2020 PRISMA statement. PubMed, Google Scholar, EMBASE, and Web of Science were accessed in August 2025. No time constraints were used for the search. All clinical studies investigating bacteriophage therapy for bacterial PJIs were considered for eligibility. Results: A total of 18 clinical studies, comprising 53 patients treated with bacteriophage therapy for PJI, were included. The mean follow-up was approximately 13.6 months. Staphylococcus aureus was the most frequent pathogen (18 cases); phage cocktails were used in 33 patients and monophage preparations in 9, all combined with suppressive antibiotic therapy. Persistent or resistant joint pain was reported in only two patients (3.8%), while signs of ongoing infection despite phage therapy were observed in four patients (7.5%). Adverse events following BT were inconsistently reported. Conclusions: Bacteriophage therapy shows promise as an adjunctive treatment for hip and knee PJIs, especially in refractory or multidrug-resistant cases. Current evidence is limited and methodologically weak, underscoring the need for well-designed clinical trials to clarify efficacy, safety, and optimal integration into existing orthopaedic infection protocols.<\/jats:p>","DOI":"10.3390\/medsci14010009","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T03:06:02Z","timestamp":1766718362000},"page":"9","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Bacteriophages in Hip and Knee Periprosthetic Joint Infections: A Promising Tool in the Era of Antibiotic Resistance"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7220-1221","authenticated-orcid":false,"given":"Filippo","family":"Migliorini","sequence":"first","affiliation":[{"name":"Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, 06097 Halle (Saale), Germany"},{"name":"Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100 Bolzano, Italy"},{"name":"Department of Life Sciences, Health, and Health Professions, Link Campus University, 00165 Rome, Italy"},{"name":"Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Kammerbruchstr. 8, 52152 Simmerath, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2047-4515","authenticated-orcid":false,"given":"Luise","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Kammerbruchstr. 8, 52152 Simmerath, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9577-9533","authenticated-orcid":false,"given":"Raju","family":"Vaishya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi 110076, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Eschweiler","sequence":"additional","affiliation":[{"name":"Department of Trauma and Reconstructive Surgery, University Hospital of Halle, Martin-Luther University Halle-Wittenberg, 06097 Halle (Saale), Germany"},{"name":"Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle GmbH, 06112 Halle (Saale), Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Oliva","sequence":"additional","affiliation":[{"name":"Department of Sports Traumatology, Universit\u00e0 Telematica San Raffaele, 00166 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3966-4237","authenticated-orcid":false,"given":"Arne","family":"Driessen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Luisenhospital, 52064 Aachen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1096-8467","authenticated-orcid":false,"given":"Gennaro","family":"Pipino","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Villa Erbosa Hospital, IRCCS Ospedale S. Raffaele, 40119 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5327-3702","authenticated-orcid":false,"given":"Nicola","family":"Maffulli","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, 00185 Roma, Italy"},{"name":"School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent ST4 7QB, UK"},{"name":"Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London E1 4DG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s10195-024-00790-2","article-title":"Can a single question replace patient-reported outcomes in the follow-up of elbow arthroplasty? 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