Abstract
Pulse lavage (PL) debridement and ultrasound are both known to be the treatment of biofilm-related periprosthetic joint infection (PJI). However, the efficacy of these in combination is unknown in eradicating biofilm from the orthopaedic metal implant surface. This study was conducted to understand the efficacy of PL and ultrasound in combination in eradicating bacterial biofilms on titanium alloy in vitro. Biofilms of Staphylococcus aureus strains were grown on titanium alloy coupons for 24 h. Then, the coupons were taken to each treatment group: (i) debrided with PL, (ii) exposed to ultrasound, or (iii) exposed to both. An untreated biofilm was set as a control group. Viable plate count and confocal microscopy using live/dead staining was used to measure the amount of biofilm. Viable plate count showed an approximate two-log reduction in CFU/cm2 in PL alone, from an initial cell count on the mental surface of approximately 109 CFU/cm2. The ultrasound caused an approximate seven-log reduction, and the combination group eradicated viable biofilm bacteria completely. Confocal imaging corroborated the CFU data. Our results indicate that PL and ultrasound both are remarkably in eradicating biofilm, and the combination of PL and ultrasound is more effective than alone in reducing biofilm.
Highlights
Periprosthetic joint infection (PJI) is one of the most dreaded complications in joint replacement surgery, which is associated with pain, prolonged hospital stays, multiple surgeries, functional incapacitation, and even mortality [1]
E bacteria cannot be detected in debridement Pulse lavage (PL) and direct-contact low-frequency ultrasound (DCLFU) exposure, which is accounting for a nine-log reduction (p < 0.05)
We investigated the effect of PL and DCLFU on eradication of biofilm formed by S. aureus on the titanium alloy surface
Summary
Periprosthetic joint infection (PJI) is one of the most dreaded complications in joint replacement surgery, which is associated with pain, prolonged hospital stays, multiple surgeries, functional incapacitation, and even mortality [1]. The incidence of PJI is below 1-2%, with increasing number of patients undergoing joint replacement surgery, more implant-associated infections could happen [2]. Ese infections include acute infections (within the first 4 weeks after implantation) and late infections, which can be derived from either a perioperative contamination of the joint or an hematogenous spreading of bacteria to the joint [3]. Staphylococcus aureus is the most commonly isolated bacteria in acute PJI cases, while coagulase-negative Staphylococcus and Streptococcus are dominant in late infections and hematogenous infections, respectively [4,5,6]. Despite recent improvements in understanding in biofilm, clinical success in eradicating PJI
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