title: Low-frequency sonication may alter surface topography of endoprosthetic components and damage articular cartilage without eradicating biofilms completely.
abstract: Two-stage exchange arthroplasty is the current standard of care for arthroplasty-related infections. Reinfection rates up to 30% are reported, and there is significant morbidity for the patient. In cases of failure, arthrodesis or amputation may result. Ultrasonic treatment has the potential to eradicate biofilms and avoid two-stage exchange arthroplasty. Data in the specific context of arthroplasty infections is scant, and there is debate regarding optimal frequency and intensity of treatment. Surface topography alterations of the endoprosthetic components and damage to adjacent bone and cartilage have not been investigated. We found incomplete biofilm eradication and significant increase in surface roughness (maximum peak-to-valley height) of cobalt-chrome unicondylar knee components as well as reduction in articular cartilage thickness area from 10 retrieved femoral heads after low-frequency sonication treatment according to manufacturer-specified recommendations. Our data collectively suggest that sonication treatment for biofilm eradication in arthroplasty infections may not be effective and surface topography alterations may potentially reduce implant longevity.
authors.affiliation: Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany; University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore, Singapore.
authors.forename: Gurpal
authors.initials: G
authors.lastname: Singh
authors.forename: Rita
authors.initials: R
authors.lastname: Hameister
authors.forename: Bernd
authors.initials: B
authors.lastname: Feuerstein
authors.forename: Friedemann
authors.initials: F
authors.lastname: Awiszus
authors.forename: Heiko
authors.initials: H
authors.lastname: Meyer
authors.forename: Christoph H
authors.initials: CH
authors.lastname: Lohmann
mesh_terms: D001422:Bacterial Adhesion; D018441:Biofilms; D002858:Chromium Alloys; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology*; D050296:Microbial Viability; D013016:Sound; D013212:Staphylococcus epidermidis / Q000502:physiology*; D013499:Surface Properties
chemical_list: D002858:Chromium Alloys
keywords: antimicrobial; arthroplasty; articular cartilage; bacterial adherence; bearing surfaces