Confirming Sterility of an Autoclaved Infected Femoral Component for Use in an Articulated Antibiotic Knee Spacer: A Pilot Study

• Published in: The Journal of arthroplasty Vol. 31; no. 1; pp. 245 - 249
• Main Authors: Lyons, Steven T., MD, Wright, Coy A., MD, Krute, Christina N., BS, Rivera, Frances E., MS, Carroll, Ronan K., PhD, Shaw, Lindsey N., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Acinetobacter baumannii; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; antibiotic spacer; Arthroplasty, Replacement, Knee - instrumentation; articulating knee spacer; autoclave; biofilm; Biofilms; Cobalt - chemistry; Enterococcus faecium; Female; Femur - surgery; Humans; infected total knee arthroplasty; Klebsiella pneumoniae; Knee Joint - surgery; Knee Prosthesis - microbiology; Male; Microscopy, Electron, Scanning; Middle Aged; Orthopedics; Pilot Projects; Prosthesis Design; Prosthesis-Related Infections - prevention & control; Prosthesis-Related Infections - surgery; Pseudomonas aeruginosa; Reoperation - instrumentation; Staphylococcus aureus; Staphylococcus epidermidis; Sterilization; Tibia - surgery; two-stage revision; antibiotic spacer; infected total knee arthroplasty; autoclave; articulating knee spacer; biofilm; two-stage revision
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2015.06.068

Abstract Antibiotic spacer designs have proven effective at eradicating infection during a two-stage revision arthroplasty. Temporary reuse of the steam-sterilized femoral component and a new all poly tibia component has been described as an effective articulating antibiotic spacer, but sterility concerns persist. Six explanted cobalt chrome femurs from patients with grossly infected TKA's and six stock femurs inoculated with different bacterial species were confirmed to be bacteria-free after autoclaving under a standard gravity-displacement cycle. The effect of steam sterilization on cobalt chrome fragments contaminated with MRSA biofilm was analyzed microscopically to quantify remaining biofilm. The autoclave significantly reduced the biofilm burden on the cobalt chrome fragments. This study confirmed sterility of the femur after a standard gravity–displacement cycle (132 °C, 27 PSIG, 10 minutes).