The Location of Biofilms on Chronic Prosthetic Joint Infections and the Ramifications for Clinical Practice

• DOI: 10.1016/j.artd.2023.101314
• Publication Date: 2024-01-25T18:36:11Z
• Authors: James B. Doub; David Parmiter; Christine A. Bran...; Matthew Moshyedi; Meghan Hughes; Matthew Kolevar; Aaron Johnson
• Keywords: Orthopedic surgery; 03 medical and health sciences; Methylene blue; 0302 clinical medicine; Biofilm; SEM; Brief Communication; Scanning electron microscopy; Periprosthetic joint infections; RD701-811

Revision surgery is paramount to cure chronic prosthetic joint infections because these infections are associated with biofilms on prosthetics that conventional antibiotics cannot eradicate. However, there is a paucity of research on where in vivo biofilms are located on infected prosthetics. Consequently, the objective of this pilot study was to address this gap in knowledge by staining 5 chronically infected prosthetics, that were removed at the time of revision surgery, with methylene blue. Scanning electron microscopic images were then taken of the methylene blue-stained areas to visualize biofilms. The findings show that all chronically infected prosthetics had biofilms located on the bone-prosthetic interface, yet only 2 had biofilms also located on the prosthetic interface exposed to synovial fluid. Subsequently, this pilot study provides a pathophysiological understanding of why the current treatment paradigm for chronic periprosthetic joint infection requires a revision surgery and not debridement and an implant retention surgery.