No abstract

We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy. All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens. Care is needed in checking irrigation fluids, and these should have a distinctive colour.

No abstract

The purpose of this study was to determine the effect of one intra-articular injection of hyaluronan on chondrocyte death and metabolism in injured cartilage. Twenty-three 6-month-old rabbits received partial-thickness articular cartilage defects created on each medial femoral condyle. In order to examine the effect on articular cartilage surrounding iatrogenic cartilage lesions, which can occur during arthroscopic procedures, Study 1 was performed: in 14 rabbits both knees were immediately rinsed with 0.9% NaCl. Experimental knees were treated with hyaluronan. Six rabbits were sacrificed at 2 days; eight rabbits 3 months postoperatively. Histomorphometric analysis was used for studying cell death in cartilage next to the defect. In order to examine the effect on longer lasting lesions, more reflecting the clinical situation, Study 2 was performed: after 6 months knee joints of nine rabbits were (i) irrigated with 0.9% NaCl, (ii) treated with hyaluronan after irrigation with 0.9% NaCl, or (iii) sham-treated. After 7 days patellas were used to study the chondrocyte metabolism by measuring the [ 35 S]sulfate incorporation. Study 1: Two days postoperatively, in hyaluronan-treated cartilage the percentage of dead cells was 6.7%, which was significantly lower compared to 16.2% in saline-treated cartilage. After 3 months the percentages of dead cells in both groups were statistically similar. Study 2: Hyaluronan treatment resulted in significantly higher [ 35 S]sulfate incorporation compared to knees irrigated with 0.9% NaCl. These results suggest a potential role for hyaluronan in preventing cell death following articular cartilage injury. One injection of hyaluronan improved cartilage metabolism in knees with 6-month-old cartilage defects. ß

We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy.All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens.Care is needed in checking irrigation fluids, and these should have a distinctive colour.J Bone Joint Surg [Br] 1998;80-B:437-40. Received 4 November 1997; Accepted 27 November 1997 Arthroscopy is now very common, and involves the use of an irrigating solution. Articular cartilage is a complex and active tissue which depends on diffusion from the synovial fluid for its nutrition and metabolism. The effect of different irrigating fluids on cartilage metabolism has previously been investigated in vitro and in animal studies; these have shown that those used most commonly have an inhibiting effect. 1,2Chlorhexidine is not normally used in arthroscopy, but is a common irrigating fluid for surgical wounds, and has been shown to help to prevent infection with Staphylococcus aureus.3 Chlorhexidine 4% was shown to have no deleterious effect on the histological appearance of wound healing of the skin in guinea-pigs. 4 Other data on the toxicity of chlorhexidine have been generally favourable, although, to our knowledge, no experiments on articular cartilage have been reported. 5We describe the macroscopic and microscopic effect of the accidental use of chlorhexidine solution during arthroscopy in six knees in five patients. Case reportsThree of the five patients were referred to us after the proven but accidental irrigation of the knee with 1% aqueous chlorhexidine during arthroscopy. There was no proof of the use of chlorhexidine in the other two patients, but the history and findings were similar. Case 1. A 26-year-old man had an arthroscopy for a lesion of the lateral meniscus in his left knee. After the operation it was discovered that aqueous chlorhexidine 1% had been used for irrigation instead of normal saline.Two months later he was referred to us with increasing pain, swelling and crepitus in the knee. He had severe loss of movement and atrophy of the quadriceps. Radiographs already showed loss of joint space in all compartments of the knee. Open debridement and synovectomy were performed, with biopsies taken for histology. The knee showed extensive chondrolysis and proliferative synovitis, but the procedure produced no improvement. After another two months arthroscopic arthrolysis and manipulation under anaesthesia also failed and progressive radiological degeneration was seen.Three years after the initial arthroscopy a further open debridement with removal of loose bodies and periarticular calcification led to spontaneous fusion of the joint in 10° of flexion. Case 2. A 21-year-old man had diagnostic ar...

This case study discusses how we diagnosed and treated a patient with a late haematogenous bilateral periprosthetic joint infection (PJI) after total knee arthroplasties caused by Ureaplasma urealyticum. This has never been reported before. We will discuss how we used a PET-CT, synovial fluid cell count, and synovial fluid analysis by 16S rRNA gene sequencing to diagnose this PJI. We will also discuss how we treated this patient to obtain full recovery.

The original version of this article unfortunately contained a mistake. The presentation of Fig. 1 was incorrect. The correct version of Fig. 1 is given below. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.