Orthopaedic surgery has low HAI incidences compared to other surgical disciplines. However, when they do occur, these infections are associated with substantial morbidity, prolonged hospital stay, exorbitant costs, and difficulties in eradication with life-long recurrence risks of around 10-20%, especially in the case of multi-resistant pathogens. Prevention remains of the utmost importance and harbours some hallmarks not shared with other surgical disciplines: low inoculum for implant infections; pathogenicity of coagulase-negative staphylococci and other skin commensals; possible haematogenous origin; and long post-discharge surveillance periods. An adequate screening and decolonization policy regarding multi-resistant pathogens, cautious antimicrobial use, and iterative epidemiologic interventions remain essential when dealing with multi-morbid patients hospitalised in specialised septic orthopaedic wards under the constant influence of high-dose and long-lasting antibiotic therapies. Among the many measures to prevent orthopaedic SSI, only some are based on strong evidence, and there is insufficient evidence to show which element is superior over any other. This highlights the need for multimodal approaches involving active post-discharge surveillance, as well as measures at every step of the care process. These range from pre-operative care to surgery and post-operative care, at the individual patient level to department-wide interventions targeting all HAI, including antibiotic stewardship. Although theoretically reducible to zero, the maximal realistic extent to decrease SSI in elective orthopaedic surgery remains unknown.