Dear Editor,

In response to the letter from Dr. Krutko, we would like to emphasize that bone resorption surrounding a spinal implant is not unique and has been already published in many other series before.

The key message of our case report [1] was the presence of a proven low-grade infection, which is still an underestimated cause of formerly described “aseptic implant failures.”

As such, the cases are different. In the case reported by Krutko et al. [2], the patient suffered from these bone changes 1 month following surgery. Therefore, this was probably not a low-grade infection which is usually present with a latency of a few years after surgery. To rule out a low-grade infection, 14-day cultures of implant sonification fluid would have been necessary.

With our case report, we want to raise awareness for low-grade infections and advocate for the use of 14-day culture from sonification fluid from the removed implant as it is established by the seminal article of Trampusz [3] for hip and knee replacements.

Best regards,

Shiban and Meyer.