477 posters, 14 topics, 2,065 authors, 1,055 institutions

The Joint EBJIS-MSIS 2026 Conference

17 - 19 September, 2026 | Porto, Portugal

EP046

A novel adjunct to DAIR for limb salvage in megaprosthesis infection: ultrasound-triggered microbubble destruction

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Poster Presenter

Noreen Hickok

Authors

Noreen Hickok, Lauren Delaney, Antonia Chen, Thomas Schaer, Priscilla Machado, Karan Goswami, Lilah Fones, Tyler Henry, Scot Brown, Flemming Forsberg

Affiliations

Thomas Jefferson University, Philadelphia, United States, University of Pennsylvania School of Veterinary Medicine, Kennett Square, United States, UT Southwestern Medical Center, Dallas, United States, Thomas Jefferson University, Rothman Orthopaedics, Philadelphia, United States

Part of Topic

Case Report

Case Study: Can ultrasound-triggered microbubble destruction (UTMD) after DAIR increase antibiotic access to the bone-implant interface to ultimately reduce PJI recurrence?

Introduction:

•Periprosthetic joint infection (PJI) of a megaprosthesis is devastating

•Debridement, antibiotics, and implant retention (DAIR) is incomplete at bone–implant interfaces

•Microbubbles are contrast agents whose ultrasound-triggered cavitational effects include shock waves, streaming, and microjets. Therapeutic uses include permeabilizing tumors for drug delivery, lysis of fibrin clots, and opening the blood brain barrier for drug access.

•In animal studies, ultrasound-triggered microbubble destruction (UTMD) augmented antibiotic action.

Clinical Presentation:

49 year old female:

•Previous right knee osteochondral sarcoma with proximal tibial resection and megaprosthesis arthroplasty and other cancers and cervical epidural abscess

•On oral suppressive therapy for abscess

•Presented to ED with new-onset right knee pain, swelling, and fever

oKnee joint aspiration yielded 97,000 white blood cells/μL in synovial fluid with 95% neutrophils—PJI?

Given the location of the PJI in the setting of a tumor megaprosthesis with limited residual host bone stock, prosthesis explantation would be associated with maximal morbidity, including the high likelihood of above-knee amputation and increased risk of mortality.

Findings:

After the two DAIR procedures and at the second UTMD procedure,

•The clinical microbiology lab reported no bacterial growth

Imaging:

•Microbubbles were clearly visible within the intraarticular space

•Microbubbles apparent along the diaphyseal bone-implant interfaces of the megaprosthesis in both the distal thigh and the distal calf

•Visibility of microbubbles/injected antibiotics show access to the bone-implant interface that cannot be directly debrided during the DAIR surgical procedure.

•At 6-months post-treatment, she was weight-bearing and ambulating with use of an assisted device.

•Her incision had completely healed without complications.

•To date, the patient has no symptoms of PJI recurrence nor signs of implant dysfunction.

•No symptoms of infection recurrence nor signs of any implant degradation or dysfunction as a result of the DAIR and UTMD treatments.

• At her latest follow up, she is doing well and proceeding with physical therapy as part of standard of care.