Osteomyelitis is a significant cause of total carcass condemnation in pigs at the slaughterhouse. The decision for total condemnation of a pig carcass for osteomyelitis is often based on traditional perceptions of the risk of pyemia, leading to controversy among Official Veterinarians (OV) in the industry. This review aims to provide a more comprehensive understanding of the etiopatho-genesis of osteomyelitis in pigs, the microorganisms involved, and the risk factors. It also high-lights the urgent need for a more uniform method to evaluate osteomyelitis cases, which could significantly reduce economic losses in the industry. Lesions originating from tail-biting, tail docking, castration, teeth resection, and raw management are described as risk factors for oste-omyelitis. Osteomyelitis is caused by the entry of pathogens into the bloodstream of the animal through an open wound. The most described pathogens are Trueperella monocytogenes, Staphylo-coccus aureus, and Streptococcus spp. At slaughter, OVs condemn carcasses with osteomyelitis due to pyemia. Signs of acute disease are essential to identify pyemia cases. In chronic cases, total carcass condemnation can be avoided depending on the number of lesions and number of vertebrae af-fected. A clear overall image of the problem would help authorities in various countries adopt a more homogenous approach.