Editorial: Bacteriophage therapy in orthopedics-Key questions and emerging answers.

Abstract

Musculoskeletal infections remain among the most challenging conditions in orthopaedic practice, often requiring prolonged antibiotic therapy, repeated surgical interventions, and extensive rehabilitation. The emergence of antimicrobial resistance and the persistence of bacterial biofilms further complicate management, particularly in chronic osteomyelitis, infected fracture fixations, and periprosthetic joint infections. In this context, bacteriophage therapy has re-emerged as a promising adjunctive strategy. Bacteriophages offer targeted antibacterial activity, including the ability to disrupt biofilms and self-replicate at the site of infection. Contemporary approaches, such as phagograms, customised phage cocktails, and local delivery techniques, have addressed many historical limitations related to phage specificity and accessibility. A growing number of case reports and small clinical series have documented successful applications of phage therapy in orthopaedic infections, with encouraging safety profiles and infection resolution in refractory cases. Early-phase clinical trials are now systematically evaluating the feasibility, pharmacokinetics, and immunogenicity of phage therapy in musculoskeletal settings. Furthermore, synergistic effects with antibiotics and the potential to overcome biofilm-related antibiotic tolerance highlight the added therapeutic value of this approach. While regulatory and manufacturing challenges persist, the integration of bacteriophages into multidisciplinary orthopaedic care marks a paradigm shift toward precision microbiology. Rather than replacing conventional treatment, phage therapy complements surgery and antibiotics, offering a biologically rational and patient-specific adjunct in the fight against recalcitrant infections.