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.

Effects of low‐frequency ultrasound treatment of titanium surface roughness on osteoblast phenotype and maturation

“…In general, the average roughness of all sonicated surfaces was lower than the untreated surfaces, particularly on PT, indicating that some ablations of the surface occurred. SEM indicated that, for the most part, the original topography was maintained and was similar to the previously published results (Zhao et al 2005;Rupp et al 2006;Gittens et al 2011;Olivares-Navarrete et al 2011;Singh et al 2014). However, defects that covered about 30% of the surface were seen on SLAson.…”

“…This typically leaves brush marks, and studies have shown that they are no longer detectable after application of low‐frequency ultrasound on CoCr‐knee prostheses (Singh et al. ). Whether a similar mechanism was involved in the present study is not clear.…”

“…Another possibility is that the production of the original PT surface before sandblasting and acid etching may have caused some marks of the metal on the surface. This typically leaves brush marks, and studies have shown that they are no longer detectable after application of low-frequency ultrasound on CoCr-knee prostheses (Singh et al 2014). Whether a similar mechanism was involved in the present study is not clear.…”

“…All three types of disks were sterilized for 12 h by gamma irradiation at 25 kGy. The chemistry and topography of these disks have been well characterized (Zhao et al 2005;Rupp et al 2006;Gittens et al 2011;Olivares-Navarrete et al 2011;Singh et al 2014).…”

Periprosthetic bacterial biofilm and quorum sensing

“…In the instance of orthopedic trauma, high pressure pulse lavage as compared to low pressure pulse lavage did not decrease the rates of reoperation, and may induce further soft tissue damage . In the case of total joint arthroplasty, pulse lavage was found to reduce the biofilm signal intensity by less than 10‐fold and low‐frequency sonication was found to not only incompletely eradicate biofilms, but also increased surface roughness of implants (maximum peak to valley height) and reduce articular cartilage thickness . Because mechanical disruption is often inadequate, removal of the infected device or implant is often necessary when possible.…”