Current explanations of biomedical alloy degradation are focused on the physicochemical mechanisms of galvanic, pitting, crevice, and fretting corrosion. Ultimately, these studies dismiss the corrosion mechanism as a function of the local microbiome. Sixty spine hardware constructs were examined immediately after explantation for biofilm formation. Marked rod sections were imaged using scanning electron microscopy with energy dispersive x-ray spectroscopy. Backscatter mode was employed to better image the topology of the surface. There is clear differentiation between discoloration due to corrosion vs mechanical damage. Under scanning electron microscopy backscatter electron shadow examination, the authors noted that not all biofilm was removed using the surgical wipes. Corrosion pits were noticeably larger and numerous in areas of biofilm. In areas not associated with biofilms, there were few pits even if mechanical wear was evident. There is no evidence that the surface corrosion is modified between clinically diagnosed infected and noninfected patients. The surface damage present on explanted Ti6Al4V spine rods is uniquely similar to damage found in other industries where microbial-influenced corrosion is prevalent. Given that similar anaerobic, sulfur-reducing bacteria reside in and on human tissues, it is most likely that corrosion observed on explanted hardware is the result of microbial-influenced corrosion and not from inflammatory or other processes. Using analysis methods from other industries to characterize the microbiome present on explanted hardware is necessary. In so doing, a new definition of hardware-induced infection will be forthcoming. [Orthopedics. 2020;43(1):62-67.].
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