Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty

Christopher, Zachary K.; Deckey, David G.; Pollock, Jordan R.; Spangehl, Mark J.

doi:10.2106/jbjs.rvw.21.00225

JBJS Reviews

2022

DOI: 10.2106/jbjs.rvw.21.00225

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Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty

Zachary K. Christopher

David G. Deckey

Jordan R. Pollock

et al.

Abstract: There are limited data that directly compare the efficacy of antiseptic irrigation solutions used for the prevention and treatment of periprosthetic joint infections in orthopaedic procedures; there is a notable lack of prospective data.

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Cited by 4 publications

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Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Hammad,

Oktarina,

Suhardi

et al. 2024

Journal Orthopaedic Research

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Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone‐iodine (PI) and hydrogen peroxide (H2O2) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone–implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H2O2, or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull‐out testing. No wound complications were observed. MicroCT scans revealed no differences in peri‐implant trabecular bone parameters. Biomechanical pull‐out testing showed no differences in the bone–implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri‐implant osteocalcin, osterix, or endomucin‐positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity.Clinical RelevanceDilute 0.3% povidone‐iodine and a 1:1 combination of 10% povidone‐iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications.

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Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Hammad,

Oktarina,

Suhardi

et al. 2024

Journal Orthopaedic Research

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Efficacy of Commercially Available Irrigation Solutions on Removal of Staphylococcus Aureus and Biofilm From Porous Titanium Implants: An In Vitro Study

Seta,

Pawlitz,

Aboona

et al. 2024

The Journal of Arthroplasty

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Principles of mechanical and chemical debridement with implant retention

et al. 2023

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Background Periprosthetic joint infection (PJI) is one of the most common causes of early revision for total hip and knee arthroplasty. Mechanical and chemical debridement typically referred to as debridement, antibiotics, and implant retention (DAIR) can be a successful technique to eradicate PJI in acute postoperative or acute hematogenous infections. This review will focus specifically on the indications, techniques, and outcomes of DAIR. Discussion The success of mechanical and chemical debridement, or a DAIR operation, is reliant on a combination of appropriate patient selection and meticulous technique. There are many technical considerations to take into consideration. One of the most important factors in the success of the DAIR procedure is the adequacy of mechanical debridement. Techniques are surgeon-specific and perhaps contribute to the large variability in the literature on the success of DAIR. Factors that have been shown to be associated with success include the exchange of modular components, performing the procedure within seven days or less of symptom onset, and possibly adjunctive rifampin or fluoroquinolone therapy, though this remains controversial. Factors that have been associated with failure include rheumatoid arthritis, age greater than 80 years, male sex, chronic renal failure, liver cirrhosis, and chronic obstructive pulmonary disease. Conclusions DAIR is an effective treatment option for the management of an acute postoperative or hematogenous PJI in the appropriately selected patient with well-fixed implants.

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Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty

Abstract: There are limited data that directly compare the efficacy of antiseptic irrigation solutions used for the prevention and treatment of periprosthetic joint infections in orthopaedic procedures; there is a notable lack of prospective data.

Cited by 4 publications

References 73 publications

Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Efficacy of Commercially Available Irrigation Solutions on Removal of Staphylococcus Aureus and Biofilm From Porous Titanium Implants: An In Vitro Study

Principles of mechanical and chemical debridement with implant retention

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