The Journal of Arthroplasty
Volume 26, Issue 6, Supplement , Pages 109-113, September 2011

Optimal Irrigation and Debridement of Infected Joint Implants:

An In Vitro Methicillin-Resistant Staphylococcus aureus Biofilm Model

  • Evan M. Schwechter, MD

      Affiliations

    • Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York
    • Corresponding Author InformationReprint requests: Evan M. Schwechter, MD, Department of Orthopaedic Surgery, Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467.
  • ,
  • David Folk, BA

      Affiliations

    • Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York
  • ,
  • Avanish K. Varshney, PhD

      Affiliations

    • Department of Medicine, Infectious Diseases, Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Bettina C. Fries, MD

      Affiliations

    • Department of Medicine, Infectious Diseases, Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, New York
  • ,
  • Sun Jin Kim, MD

      Affiliations

    • Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York
  • ,
  • David M. Hirsh, MD

      Affiliations

    • Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York

Received 13 July 2010; accepted 31 March 2011. published online 06 June 2011.

Abstract 

Acute postoperative and acute, late hematogenous prosthetic joint infections have been treated with 1-stage irrigation and debridement with polyethylene exchange. Success rates, however, are highly variable. Reported studies demonstrate that detergents are effective at decreasing bacterial colony counts on orthopedic implants. Our hypothesis is that the combination of a detergent and an antiseptic would be more effective than using a detergent alone to decrease colony counts from a methicillin-resistant Staphylococcus aureus biofilm-coated titanium alloy disk simulating an orthopedic implant. In our study of various agents tested, chlorhexidine gluconate scrub (antiseptic and detergent) was the most effective at decreasing bacterial colony counts both prereincubation and postreincubation of the disks; pulse lavage and scrubbing were not more effective than pulse lavage alone.

Keywords: joint infection, debridement, optimal irrigation, MRSA, biofilm

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 The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.03.042.

PII: S0883-5403(11)00154-9

doi:10.1016/j.arth.2011.03.042

The Journal of Arthroplasty
Volume 26, Issue 6, Supplement , Pages 109-113, September 2011