Direct Demonstration of Viable Staphylococcus aureus Biofilms in an Infected Total Joint Arthroplasty

Infection following total joint arthroplasty is difficult to diagnose and treat; a nascent body of evidence from studies of prosthetic joint infections suggests that biofilm bacteria are the underlying cause1-3. We describe the case of a patient who had chronic recurring symptoms of infection that persisted for years following total elbow arthroplasty despite numerous medical and surgical interventions. Confocal microscopy performed on fluid, tissue, and cement at the final surgical revision demonstrated viable bacteria in biofilm aggregates. Reverse transcriptase-polymerase chain reaction analysis confirmed the presence of metabolically active Staphylococcus aureus. These observations comprise compelling evidence that viable biofilm bacteria play an important role in refractory infection following joint arthroplasty.