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

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.

翻修手术对于治疗慢性人工关节感染至关重要，因为这些感染与假体上的生物膜有关，常规抗生素无法根除生物膜。然而，对于体内生物膜在感染假体上的位置，相关研究匮乏。因此，这项初步研究的目的是通过用亚甲蓝对5个在翻修手术时取出的慢性感染假体进行染色，来填补这一知识空白。然后对亚甲蓝染色区域拍摄扫描电子显微镜图像以观察生物膜。研究结果显示，所有慢性感染的假体在骨 - 假体界面都有生物膜，但只有2个在暴露于滑液的假体界面也有生物膜。随后，这项初步研究从病理生理学角度解释了为什么当前慢性假体周围关节感染的治疗模式需要翻修手术，而不是清创和保留植入物的手术。