Effective treatment using a single-stage revision with non-contact low frequency ultrasonic debridement in the treatment of periprosthetic joint infection : a prospective single-arm study.

Abstract

Aims: In the surgical treatment of a periprosthetic joint infection (PJI), traditional mechanical debridement can only remove visibly infected tissue; not all of the biofilms can be removed. The aim of this study was to report the results of a single-stage revision using non-contact low-frequency ultrasonic debridement (NLFUD) in the treatment of chronic PJIs.

Methods: This was a prospective study of patients undergoing single-stage revision for chronic PJI, between August 2021 and June 2022. After mechanical debridement, an 8 mm handheld non-contact low-frequency ultrasound probe was used for debridement at a frequency of 25 ± 5 kHz and power of 90%, for five minutes. Each debridement lasted for ten seconds, with three-second intervals. The probe repeatedly sonicated all soft-tissue and bony surfaces. Before and after NLFUD, 25 ml of fluid was extracted from the surgical field for bacterial culture and counting. Chemical debridement was then used to irrigate the whole field. The bacteriological findings, recurrence of infection, and complications were recorded.

Results: A total of 45 patients (25 infected total hip arthroplasties (THAs) and 20 infected total knee arthroplasties (TKAs)) were included. Overall, 43 patients (95.6%) were free of infection at a mean follow-up of 29 months (24 to 33). There were no complications relating to the ultrasonic debridement, with no neurovascular or muscle injury, no poor wound healing, and no fat liquefaction. The rate of positive culture in the fluid from the surgical field before ultrasonic debridement was 40.0% (18/45), and it significantly increased to 75.6% (34/45) after ultrasonic debridement (p = 0.001). The median number of colony-forming units (CFUs) before debridement was 307 CFU/ml (IQR 225 to 585) significantly improved to 2,372 CFUs/ml (IQR 2,045 to 2,685; p < 0.001) after debridement.

Conclusion: We found that a favourable short-term control of infection can be achieved in these patients by a single-stage revision using NLFUD, without associated complications. However, further robust evidence is required to confirm the clinical benefits of using NLFUD under these circumstances.