Clinical Effectiveness of a Biofilm Disrupting Surgical Lavage in Reducing Bacterial Plate Counts in Total Knee Arthroplasty Revision Surgery in Known Cases of Prosthetic Joint Infection

Introduction: Bacteria can cycle between two distinct modes of growth, as free-floating “planktonic” and attached “biofilm.” Opportunistically seizing hold of acute and chronic wounds once established (often in as few as 15 minutes to two hours from inoculation), biofilms are exceptionally resilient and require extreme countermeasures to remove. Biofilms can form on any surface, from skin to foreign objects and medical devices. Thus, biofilm plays an important role in any infection, including acute battlefield trauma wounds, downstream surgical interventions after prolonged field care, and as adjunctive treatment for open joint procedures. It is vital to incorporate biofilm-disrupting technology in the use of infection prevention and post-infection mitigation using wound and surgical lavage. The objective of this 40-patient study is to demonstrate a reduction in fluid cell counts in aspirate acquired from primary or stage 1 revision total knee arthroplasty patients diagnosed with prosthetic joint or surgical site infections using a biofilm-disrupting surgical lavage.

Results: Cell counts were compared before and after articular irrigation. The WBC cell count served as the proxy for particulate and cellular matter in the articular wound. In this study, we were able to show reduced bio-burden and bacterial count within the surgical site after use of the surgical lavage even among a broad-spectrum of resistant organisms. Data were obtained on all 40 patients for WBC counting.

Conclusion: The use of a biofilm-disrupting wound wash/irrigation solution at the point of injury or subsequently prior to a surgical closure significantly reduces the bio-burden and bacterial count at the injury or surgical site. There is a wide range of biodiversity present within both new wounds, especially in battlefield situations and within surgical sites presumed sterile. As an effective countermeasure to foreign or domestic pathogens, rapid pathogen eradication is critical for immediate protection from infection and the ongoing threat of infection.