Clin Orthop Surg.  2018 Dec;10(4):427-432. 10.4055/cios.2018.10.4.427.

Safety of Temporary Use of Recycled Autoclaved Femoral Components in Infected Total Knee Arthroplasty: Confirming Sterility Using a Sonication Method

• Park HJ
• Kim HJ
• Kim S
• Kim SM
• Mun JU
• Kim J
• Kyung HS

• KMID: 2426527
• DOI: http://doi.org/10.4055/cios.2018.10.4.427

Abstract

BACKGROUND
The purpose of this study was to evaluate the usefulness of sonication technique for microbiological diagnosis and the sterility of the recycled autoclaved femoral components from infected total knee arthroplasty (TKA) using a sonication method.
METHODS
Nineteen femoral implants explanted from patients with infected TKA were sterilized with a standard autoclave method. Standard culture of the fluid before and after sonication of the sterilized implants was performed to detect pathogenic microorganisms. Additional experiments were performed to evaluate the sterility of the recycled implant by inducing artificial biofilm formation. Methicillin-resistant Staphylococcus aureus (MRSA) was inoculated into 10 implants and sterilization in a standard autoclave was performed, and then the fluid was cultured before and after sonication.
RESULTS
Two of the 19 sterilized implants were positive for growth of bacteria after sonication, whereas no growth was detected in the cultured fluid from the sterilized implants before sonication. The bacteria were Staphylococcus species in all two cases. In one of 10 implants inoculated with MRSA, the culture was positive for growth of bacteria both before and after sonication. However, Staphylococcus epidermidis was cultured from both occasions and thus this implant was thought to be contaminated.
CONCLUSIONS
We found sonication for identification of pathogens could be helpful, but this finding should be interpreted carefully because of the possibility of contamination. Sterilization of an infected femoral implant with an autoclave method could be a good method for using the temporary articulating antibiotic spacer in two-stage revision arthroplasty.

Keyword

Infection; Total knee arthroplasty; Sonication; Periprosthetic joint infection

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Knee*
Bacteria
Biofilms
Diagnosis
Humans
Infertility*
Methicillin-Resistant Staphylococcus aureus
Methods*
Sonication*
Staphylococcus
Staphylococcus epidermidis
Sterilization

Figure

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  Fig. 1 The implants were aseptically transferred into a stomacher bag and 400 mL of sterile saline was added to the stomacher bag.

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  Fig. 2 The stomacher bag with 400 mL of saline and implant was subjected to sonication.

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