title: High hydrostatic pressure for disinfection of bone grafts and biomaterials: an experimental study.
abstract: BACKGROUND
  Autoclaving, heat, irradiation or chemical detergents are used to disinfect autografts, allografts and biomaterials for tissue reconstruction. These methods are often associated with deterioration of mechanical, physical, and biological properties of the bone grafts and synthetic implants. High hydrostatic pressure has been proposed as a novel method preserving biomechanical and biological properties of bone, tendon and cartilage. This is the first study to assess the inactivation of clinically relevant bacteria on biomaterials and human bone by high hydrostatic pressure.
  
  
  METHODS
  Bacterial suspensions of Staphylococcus aureus, Pseudomonas aeruginosa and Enterococcus faecium, implants covered with infected blood, human bone infected in vitro, and biopsies of patients with chronic osteomyelitis were subjected to different protocols of high hydrostatic pressure up to 600 MPa. Bacterial survival after high hydrostatic pressure treatment was determined and compared with bacterial growth in untreated controls.
  
  
  RESULTS
  S. aureus and P. aeruginosa in suspension were completely inactivated by high hydrostatic pressure (> 5log levels), whereas E. faecium showed barotolerance up to 600 MPa. Blood and adherence to metal implants did not significantly alter inactivation of bacteria, and complete disinfection was achieved with barotolerant bacteria (S. aureus and P. aeruginosa). However, osteoarthritic bone demonstrated a non-homogeneous baroprotective effect, with single bone samples resistant to treatment resulting in unaltered bacterial growth, and complete disinfection of artificially infected bone specimens was achieved in 66% for S. aureus, 60% for P. aeruginosa and 0% for E. faecium. Human bone samples of patients with chronic osteomyelitis could be completely disinfected in 2 of 37 cases.
  
  
  CONCLUSIONS
  High hydrostatic pressure offers new perspectives for disinfection of sensitive biomaterials and bone grafts, and contamination by blood did not significantly affect bacterial inactivation rates. However, a significant baroprotective effect was demonstrated in bone. Effectiveness is currently limited to colonization and / or infection with barosensitive micro-organisms.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Technische Universität München, Ismaninger Strasse 22, 81675 München, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Gollwitzer
authors.forename: Wolfram
authors.initials: W
authors.lastname: Mittelmeier
authors.forename: Monika
authors.initials: M
authors.lastname: Brendle
authors.forename: Patrick
authors.initials: P
authors.lastname: Weber
authors.forename: Thomas
authors.initials: T
authors.lastname: Miethke
authors.forename: Gunther O
authors.initials: GO
authors.lastname: Hofmann
authors.forename: Ludger
authors.initials: L
authors.lastname: Gerdesmeyer
authors.forename: Johannes
authors.initials: J
authors.lastname: Schauwecker
authors.forename: Peter
authors.initials: P
authors.lastname: Diehl