Section of Orthopedic Surgery, Ascension Providence Hospital, Southfield, Michigan.
Section of Orthopedic Surgery, Ascension Providence Hospital, Southfield, Michigan; Virotech Co, Inc, Troy, Michigan.
J Arthroplasty. 2024 Sep;39(9S1):S292-S298. doi: 10.1016/j.arth.2024.06.024. Epub 2024 Jun 16.
Periprosthetic joint infection remains a major problem. The bactericidal efficacy of commercial irrigation solutions for the treatment of infection is not well established in the presence of porous titanium (Ti) implants. This study compared the in vitro efficacy of five irrigation solutions on infected three-dimensional-printed porous Ti discs.
Titanium discs (2 × 4 mm, 400, 700, and 1,000 μm) were infected with S. aureus (1 × 10 colony-forming unit/mL) and incubated for 3 hours or 3 days to create acute or chronic infection with biofilm. Discs were irrigated with saline, antibiotic, or antiseptic solutions, then repeatedly sonicated. Sonicates were cultured for bacterial quantification. Statistical analyses were performed using one-way analysis of variance (ANOVA), followed by Tukey-Kramer post hoc testing (P < .05 significance). Biofilms were visualized by scanning electron microscopy.
Saline irrigation was ineffective in both groups. In acute infections with 400 μm pores, differences were found with saline versus solution #3 (P = .015) and #4 (P = .015). Solution #4 had the lowest bacterial counts for all pore sizes. For biofilm, irrigation with saline, solutions #1, #2, and #3 inadequately cleared bacteria in all pore sizes. Lower remaining concentrations were observed in #4 with 400μm pores compared to saline (P = .06) and #2 (P = .039). The scanning electron microscopy showed a reduction of biofilm in samples washed with #4.
Irrigation of infected porous Ti discs with saline, solutions #1 and #2 failed to reduce the bacterial load. The 400 μm discs consistently had more bacteria despite irrigation, highlighting the difficulty of removing bacteria from small pores. Solutions #3 and #4 reduced bacteria acutely, but only #4 demonstrated efficacy in clearing biofilm compared to saline. These results should be considered when treating periprosthetic joint infection in the presence of porous components and the potential presence of biofilm.
假体周围关节感染仍然是一个主要问题。在存在多孔钛（Ti）植入物的情况下，商业冲洗液治疗感染的杀菌效果尚未得到充分证实。本研究比较了五种冲洗液对感染的三维打印多孔 Ti 盘的体外疗效。
Ti 盘（2×4mm，400、700 和 1000μm）用金黄色葡萄球菌（1×10 个菌落形成单位/mL）感染，孵育 3 小时或 3 天，以形成急性或慢性感染生物膜。用生理盐水、抗生素或防腐剂溶液冲洗圆盘，然后反复超声处理。超声处理物进行细菌定量培养。使用单向方差分析（ANOVA）进行统计分析，然后进行 Tukey-Kramer 事后检验（P<.05 有统计学意义）。生物膜通过扫描电子显微镜进行可视化。
在两组中，生理盐水冲洗均无效。在 400μm 孔的急性感染中，与生理盐水相比，溶液#3（P=.015）和#4（P=.015）有差异。对于所有孔径，溶液#4 的细菌计数最低。对于生物膜，在所有孔径下，用生理盐水、溶液#1、#2 和#3 冲洗均不能充分清除细菌。与生理盐水（P=.06）和#2（P=.039）相比，在 400μm 孔中观察到溶液#4 的残留浓度较低。扫描电子显微镜显示，用#4 冲洗的样品中的生物膜减少。
用生理盐水、溶液#1 和#2 冲洗感染的多孔 Ti 盘未能降低细菌负荷。尽管冲洗，但 400μm 盘始终具有更多的细菌，这突出表明从小孔中去除细菌的困难。溶液#3 和#4 可在急性感染时减少细菌，但只有#4 与生理盐水相比在清除生物膜方面显示出疗效。在存在多孔成分和生物膜的潜在存在的情况下，治疗假体周围关节感染时，应考虑这些结果。
