International Consensus Meeting on Orthopaedic Infection: Differences Between ICM 2018 and ICM 2025

Abstract

Background: Periprosthetic joint infection (PJI) remains one of the most devastating complications after total joint arthroplasty. The International Consensus Meeting (ICM) has emerged as the leading global initiative to provide evidence-based recommendations on the prevention, diagnosis, and management of PJI. This study compares the recommendations of the 2018 and 2025 ICMs to assess how evolving evidence has shaped clinical guidance. Methods: A total of 172 comparable questions were identified across thematic areas, including general, biofilm, hip and knee, shoulder, and spine. Results: Changes in recommendations were observed in 37 questions (21.5%), while 33 (19.2%) were supported by stronger evidence in 2025 and 42 (24.4%) by weaker evidence. Notable evolution included recognition of the increased revision risk following total knee arthroplasty (TKA) after prior ipsilateral arthroscopy, the establishment of a minimum 12-week antibiotic regimen after debridement, antibiotics, and implant retention (DAIR) for acute PJI, and updated guidance on the role of repeat DAIR procedures. Beyond content, the 2025 ICM adopted more directive language with explicit grading of evidence and consensus strength, providing clearer clinical guidance. Conclusions: These findings highlight how the rapid generation of high-quality evidence has transformed consensus recommendations, underscoring the central role of ICM in harmonizing global practice and defining research priorities in the management of PJI. (c) 2025 Published by Elsevier Inc.