Effective therapy for periprosthetic joint infection through sequential application of non-contact low-frequency ultrasonic debridement and antiseptic solutions

作者：Fei Wang, Yicheng Li, Boyong Xu, Xiaogang Zhang, Weilu Mu, W T Guo, Abudousaimi Aimaiti, Tuerhongjiang Wahafu, Dewen Xue, Li YICHANG, Baochao Ji, Li Cao · 发表于：Bone and Joint Research · 年份：2026 · DOI：10.1302/2046-3758.154.bjr-2025-0452.r1 · 研究领域：Orthopedic Infections and Treatments、Orthopaedic implants and arthroplasty、Total Knee Arthroplasty Outcomes

Aims Conventional mechanical debridement may be insufficient to fully eradicate biofilms adherent to prosthetic and surrounding tissue surfaces in cases of periprosthetic joint infection (PJI). This study aimed to evaluate the eradication efficacy and safety of non-contact low-frequency ultrasonic debridement (NLFUD) combined with antiseptic solutions against Staphylococcus aureus biofilms. Methods Ex vivo, sequential NLFUD was followed by one of four antiseptic protocols (0.9% saline, 3% H 2 O 2 , 0.5% povidone-iodine (PI), or 3% H 2 O 2 then 0.5% PI) to eliminate S. aureus biofilms on titanium discs, and evaluated eradication efficacy by live/dead staining and scanning electron microscopy (SEM). In vivo, the approach was subsequently evaluated in a S. aureus -infected PJI rat model comprising four groups: mechanical debridement alone, mechanical and chemical debridement, mechanical and NLFUD debridement, and combined mechanical, NLFUD, and chemical debridement. In vivo, biofilm disruption was assessed by SEM, and safety by haematology, hepatorenal function, major-organ histology, local angiogenic/inflammatory markers, and periprosthetic bone integration. Results NLFUD combined with each antiseptic produced residual live and dead biofilm areas of < 1%. NLFUD + PI and NLFUD + H 2 O 2 + PI groups exhibited no bacterial regrowth. SEM analysis confirmed effective biofilm disruption using NLFUD on titanium discs ex vivo and on titanium alloy prosthesis in vivo. NLFUD treatment...