Pulse lavage is inadequate at removal of biofilm from the surface of total knee arthroplasty materials.
In acute periprosthetic infection, irrigation and debridement with component retention has a high failure rate in some studies. We hypothesize that pulse lavage irrigation is ineffective at removing biofilm from total knee arthroplasty (TKA) components. Staphylococcus aureus biofilm mass and location was directly visualized on arthroplasty materials with a photon collection camera and laser scanning confocal microscopy. There was a substantial reduction in biofilm signal intensity, but the reduction was less than a ten-fold decrease. This suggests that irrigation needs to be further improved for the removal of biofilm mass below the necessary bioburden level to prevent recurrence of acute infection in total knee arthroplasty.
Department of Orthopaedics and Rehabilitation, Division of Musculoskeletal Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
Kenneth L
KL
Urish
College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
Peter W
PW
DeMuth
Department of Pathology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
David W
DW
Craft
Orthopaedics Biomechanics & Advanced Surgical Technologies Laboratory, Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebrasca.
Hani
H
Haider
Department of Orthopaedics and Rehabilitation, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania.
Charles M
CM
Davis
D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D018441:Biofilms; D004866:Equipment Contamination; D007720:Knee Prosthesis / Q000382:microbiology*; D018613:Microscopy, Confocal; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D007507:Therapeutic Irrigation
biofilm; periprosthetic joint infection; pulse lavage; single stage irrigation debridement; total knee arthroplasty