Pulse Lavage is Inadequate at Removal of Biofilm from the Surface of Total Knee Arthroplasty Materials
Section snippets
Biofilm Culture and Debridement
A clinically isolated methicillin sensitive strain of Staphylococcus aureus (Xen 29, Caliper, Waltham, MA) transfected with luciferase to allow visualization with a bioluminescent photon collection camera was selected. Cobalt chrome metal, polymethyl methacrylate (PMMA), and polyethylene (ultra-high molecular weight polyethylene) coupons (Fig. 1) were inoculated with S. aureus at an absorbance optical density of 0.5 in tryptic soy broth media for 24 hours in an agitating water bath (37 ºC, 30
Results
To test the hypothesis that pulse lavage was ineffective at removing biofilm from TKA components, bioluminescence S. aureus was used to macroscopically visualize and quantify biofilm debridement (Fig. 1). A large bioluminescent signal could be visualized following pulse lavage on PMMA and polyethylene. The signal on the cobalt coupons was below the visible threshold scale to allow comparison to the other materials, but still did have a signal above control comparisons as discussed below.
The
Discussion
The establishment of a biofilm on TKA components is believed to be responsible for the high failure rate of single stage irrigation and debridement with component retention. The inability of pulse lavage to remove substantial mass of biofilm from TKA components is anecdotally held, but there is a remarkable absence of evidence supporting this hypothesis in the literature. Our results used direct visualization and quantification of the remaining biofilm to demonstrate pulse lavage irrigation
Acknowledgments
The authors would like to thank Warren O. Haggard PhD with the Department of Biomedical Engineering at the University of Memphis for his expert technical assistance with bioluminescent bacteria and imaging.
References (30)
The Insall-Burstein II prosthesis: a 5- to 9-year follow-up study in osteoarthritic knees
J Arthroplasty
(2002)Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty
J Arthroplasty
(1997)The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components
J Arthroplasty
(2009)Biofilm removal by medical device cleaners: comparison of two bioreactor detection assays
J Hosp Infect
(2010)Optimal irrigation and debridement of infected joint implants: an in vitro methicillin-resistant Staphylococcus aureus biofilm model
J Arthroplasty
(2011)The epidemiology of revision total knee arthroplasty in the United States
Clin Orthop Relat Res
(2009)Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population
Arch Intern Med
(2008)Long-term followup of the Miller-Galante total knee replacement
Clin Orthop Relat Res
(2001)Long-term followup of nonmodular total knee replacements
Clin Orthop Relat Res
(2002)Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030
J Bone Joint Surg Am
(2007)
Early failures in total knee arthroplasty
Clin Orthop Relat Res
The Chitranjan Ranawat Award: Long-term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties
Clin Orthop Relat Res
Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases
J Bone Joint Surg Am
Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention
Clin Infect Dis
Open debridement of acute gram-positive infections after total knee arthroplasty
Clin Orthop Relat Res
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Funding support was provided in part by the Woodward Family Endowment in Biomedical Engineering and the Pellegrini Endowment to the Department of Orthopaedics and Rehabilitation at the Pennsylvania State University. Laboratory facilities and equipment were partially provided by Dr. Dani Zander, Department of Pathology at the Pennsylvania State College of Medicine.
The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.12.012.