Böhle Sabrina, Horbert Victoria, Rohe Sebastian, Lindemann Chris, Röhner Eric, Matziolis Georg
Orthopaedics University Hospital Jena, Campus Eisenberg, Waldkliniken Eisenberg, Friedrich-Schiller-University, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
Orthopaedic Department, Heinrich-Braun-Klinikum, 08060, Zwickau, Germany.
Sci Rep. 2025 Aug 26;15(1):31375. doi: 10.1038/s41598-025-16834-4.
With the increasing number of total joint arthroplasties and the associated increase in periprosthetic infections, the further development of non-invasive examination methods to improve bacterial detection is becoming increasingly important. This is particularly important in the case of biofilm-forming bacteria, where false-negative results from joint puncture can lead to a delay in optimal therapy, as the number of planktonic bacteria in the punctate can be low. Extracorporeal shock wave therapy, originally used in the treatment of urolithiasis, has demonstrated promising energy-dependent biofilm-disrupting and even antimicrobial properties against Staphylococcus aureus. High-energy shock waves have been shown to be effective in several studies, but they are often painful and not suitable for all patients. Utilizing shock waves could enhance pathogen detection rates and potentially enable the early initiation of targeted therapy. This study therefore investigates whether low-energy shock waves are suitable for removing bacteria from a Staphylococcus aureus biofilm on polyethylene. The aim of this study is to evaluate the applicability of this method to improve the diagnostic accuracy of periprosthetic infections. In an in vitro model, Staphylococcus aureus biofilms were cultured on polyethylene patellas for 48 h. Biofilm disruption by low-energy shock waves was tested using a ReflecTron hmt device, with shock waves applied in a range of 0-1800 impulses. Colony-forming units (CFU) and XTT assays (to quantify cell viability) were measured. Shock wave treatment with an energy of 0.13 mJ/mm proved to be effective in removing bacteria from Staphylococcus aureus biofilms on polyethylene surfaces. A significant increase in CFU within the surrounding solution was observed after just 100 impulses (p = 0.018), and continued to increase until approximately 900 impulses. A linear correlation was identified between the logarithm of the shock wave impulses and both the CFU (r = 0.971, p < 0.001) and the XTT activity (r = 0.94, p < 0.001). This finding suggests that low-energy shock waves detach living bacteria from the biofilm. Consequently, they highlight the potential of low-energy shock waves to effectively disrupt biofilms without compromising bacterial viability, reinforcing their potential diagnostic and therapeutic applications. Low-energy shock waves disrupt Staphylococcus aureus biofilms on polyethylene surfaces in vitro, dislodging bacteria from the biofilm. However, further in vivo studies are required in order to assess the potential of this method for clinical applications. Such studies could determine whether shock waves can enhance periprosthetic infection diagnosis in vivo and facilitate implant-preserving therapies for mature biofilms.
随着全关节置换手术数量的增加以及假体周围感染的相应增多，进一步开发非侵入性检查方法以提高细菌检测能力变得越发重要。这在形成生物膜的细菌感染情况中尤为重要，因为关节穿刺的假阴性结果可能导致最佳治疗的延迟，因为穿刺液中浮游细菌的数量可能很少。体外冲击波疗法最初用于治疗尿路结石，已显示出对金黄色葡萄球菌具有有前景的能量依赖性生物膜破坏甚至抗菌特性。多项研究表明高能冲击波有效，但它们通常会引起疼痛，且并非适用于所有患者。利用冲击波可以提高病原体检测率，并有可能使靶向治疗得以早期启动。因此，本研究调查低能量冲击波是否适合从聚乙烯上的金黄色葡萄球菌生物膜中去除细菌。本研究的目的是评估该方法在提高假体周围感染诊断准确性方面的适用性。在体外模型中，金黄色葡萄球菌生物膜在聚乙烯髌骨上培养48小时。使用ReflecTron hmt设备测试低能量冲击波对生物膜的破坏作用，施加的冲击波脉冲范围为0至1800次。测量菌落形成单位（CFU）和XTT测定（用于量化细胞活力）。结果证明，能量为0.13 mJ/mm的冲击波治疗可有效从聚乙烯表面的金黄色葡萄球菌生物膜中去除细菌。仅在100次脉冲后，周围溶液中的CFU就显著增加（p = 0.018），并持续增加直至约900次脉冲。在冲击波脉冲的对数与CFU（r = 0.971，p <0.001）和XTT活性（r = 0.94，p <0.001）之间确定了线性相关性。这一发现表明低能量冲击波可使活细菌从生物膜上脱离。因此，它们凸显了低能量冲击波在不损害细菌活力的情况下有效破坏生物膜的潜力，增强了其潜在的诊断和治疗应用价值。低能量冲击波在体外破坏聚乙烯表面的金黄色葡萄球菌生物膜，使细菌从生物膜上脱落。然而，需要进一步的体内研究来评估该方法在临床应用中的潜力。此类研究可以确定冲击波是否能在体内增强假体周围感染的诊断，并促进对成熟生物膜的保留植入物治疗。
