The Infected Polypropylene Mesh: When Does Biofilm Form and Which Antiseptic Solution Most Effectively Removes It?

Suenghwan Jo; Christina Chao; Tyler K Khilnani; Aarti Shenoy; Mathias P G Bostrom; Alberto V Carli

doi:10.1016/j.arth.2024.04.081

The Infected Polypropylene Mesh: When Does Biofilm Form and Which Antiseptic Solution Most Effectively Removes It?

J Arthroplasty. 2024 May 8:S0883-5403(24)00429-7. doi: 10.1016/j.arth.2024.04.081. Online ahead of print.

Authors

Suenghwan Jo¹, Christina Chao², Tyler K Khilnani², Aarti Shenoy³, Mathias P G Bostrom², Alberto V Carli²

Affiliations

¹ School of Medicine, Chosun University, Gwangju, South Korea.
² Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.
³ Department of Biomechanics, Hospital for Special Surgery, New York, New York.

PMID: 38723699
DOI: 10.1016/j.arth.2024.04.081

Abstract

Background: Polypropylene (PPE) mesh is commonly utilized to reconstruct catastrophic extensor mechanism disruptions in revision total knee arthroplasty. Unfortunately, these procedures are associated with a high rate of periprosthetic joint infection. The purpose of the current study was to: 1) visualize and quantify the progression of bacterial biofilm growth on PPE-mesh; and 2) determine which antiseptic solutions effectively remove viable bacteria.

Methods: Knitted PPE mesh samples were cultured with either methicillin-sensitive Staphylococcus aureus (MSSA) or Escherichia coli (E. coli) for 7 days, with regular quantification of colony forming units (CFUs) and visualization using scanning electron microscopy to identify maturity. Immature (24 hour) and mature (72 hour) biofilm was treated with one of 5 commercial antiseptics for 3 minutes. A 0.05% chlorhexidine gluconate, a surfactant-based formulation of ethanol, acetic acid, sodium acetate, benzalkonium chloride, diluted povidone-iodine (0.35%), undiluted (10%) povidone-iodine, and 1:1 combination of 10% povidone-iodine and 3% hydrogen peroxide. A 3-log reduction in CFUs compared to saline was considered clinically meaningful.

Results: The CFU counts plateaued, indicating maturity, at 72 hours for both MSSA and E. coli. The scanning electron microscopy confirmed confluent biofilm formation after 72 hours. The 10% povidone-iodine was clinically effective against all MSSA biofilms and immature E. coli biofilms. The 10% povidone-iodine with hydrogen peroxide was effective in all conditions. Only 10% povidone iodine formulations produced significantly (P < .0083) reduced CFU counts against mature biofilms.

Conclusions: Bacteria rapidly form biofilm on PPE mesh. Mesh contamination can be catastrophic, and clinicians should consider utilizing an antiseptic solution at the conclusion of mesh implantation. Undiluted povidone-iodine with hydrogen peroxide should be considered when attempting to salvage infected PPE mesh.

Keywords: biofilm; extensor mechanism reconstruction; irrigation solutions; mesh; polypropylene.