Abstract Musculoskeletal infections remain a formidable challenge in orthopaedic surgery, particularly when biofilm formation and antimicrobial resistance compromise the efficacy of conventional treatment, typically including repeated surgical debridement, implant removal or exchange, and prolonged systemic antibiotic administration. Bacteriophage therapy, once relegated to historical anecdote, has re-emerged as a biologically targeted adjunct capable of eradicating pathogenic bacteria in complex musculoskeletal environments. This narrative review synthesises current knowledge on the use of bacteriophages in musculoskeletal infections, with critical emphasis on preclinical efficacy, clinical application, and integration within standard surgical and antibiotic regimens. Data from in vitro studies, animal models, and human case series consistently demonstrate phage-mediated biofilm disruption, synergy with antimicrobials, and favourable safety profiles. Nevertheless, key limitations remain, including immunogenicity, pharmacokinetic unpredictability, manufacturing standardisation, and regulatory heterogeneity. Addressing these barriers requires robust pharmacological modelling, molecular diagnostics, and harmonised regulatory frameworks. Phage therapy is currently in a crucial phase of translational development and, following rigorous scientific validation, it may become an essential pillar of infection management in orthopaedics.
Migliorini et al. (Thu,) studied this question.