Clinical and pathological changes in the knee after accidental chlorhexidine irrigation during arthroscopy: Case reports and review of the literature

Douw, C. M.; Bulstra, S. K.; Vandenbroucke, Johan; Geesink, R. G. T.; Vermeulen, Anton H. M.

doi:10.1302/0301-620x.80b3.8519

Cited by 49 publications

(40 citation statements)

References 6 publications

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“…Different case reports show toxic effects of chlorhexidine on human cartilage after open or arthroscopic surgery. In all cases, unspecified or high concentrations of chlorhexidine were used for an undefined time of treatment [24][25][26][27]. The impact of chlorhexidine on primary human osteoblasts is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Human osteoblast damage after antiseptic treatment

Vörös

Dobrindt

Perka

et al. 2013

International Orthopaedics (SICOT)

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Purpose Antiseptics are powerful medical agents used for wound treatment and decontamination and have a high potential for defeating joint infections in septic surgery. Both chlorhexidine and polyhexanide are frequently used in clinical practice and have a broad antimicrobial range, but their effect on human osteoblasts has not been sufficiently studied. Our objective was to investigate the toxic effects of polyhexanide and chlorhexidine on human osteoblasts in vitro to evaluate their clinical applicability in septic surgery. Methods We isolated and cultivated human osteoblasts in vitro and assayed the toxic effects of chlorhexidine 0.1 % and polyhexanide 0.04 %, concentrations commonly applied in clinical practice. Toxicity analysis was performed by visualisation of cell structure, lactate dehydrogenase (LDH) activity and evaluation of vital cells. Toxicity was evaluated by microscopic inspection of cell morphology, trypan blue staining and determination of LDH release. Results Damaged cell structure could be shown by microscopy. Both antiseptics promoted LDH activity after incubation with osteoblasts. The evaluation of vital osteoblasts showed a significant decrease of vital cells. Conclusions Both antiseptics induced significant cell death of osteoblasts at optimum exposure. We therefore recommend cautious use of polyhexanide and chlorhexidine in septic surgery to avoid severe osteoblast toxicity.

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Section: Introductionmentioning

confidence: 99%

Human osteoblast damage after antiseptic treatment

Vörös

Dobrindt

Perka

et al. 2013

International Orthopaedics (SICOT)

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“…Some joints appear more prone to development of articular chondrolysis than others: chondrolysis is relatively common in the hip as compared with in smaller joints such as the shoulder or ankle [2]. Postarthroscopic chondrolysis has been reported in not only the shoulder but also the knee [6,15,27] and ankle [2].…”

Section: Discussionmentioning

confidence: 99%

“…van Huyssteen and Bracey [27] and Douw et al [6] reported acute chondrolysis of the knee after arthroscopy involving accidental use of chlorhexidine. Douw et al described three patients (four knees) who underwent knee arthroscopy; all their knees were accidentally irrigated with 1% aqueous chlorhexidine instead of plain saline.…”

Section: Discussionmentioning

confidence: 99%

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Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps

Anakwenze

Hosalkar

Huffman

2010

Clinical Orthopaedics &Amp; Related Research

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Background Acute idiopathic chondrolysis in young adults is rare. The etiology often is unknown and outcomes can be devastating owing to rapid development of painful secondary osteoarthritis. There have been some recent reports of chondrolysis after arthroscopic shoulder procedures. Animal and laboratory data suggest chondrolysis is related to the use of intraarticular pain pumps, although there is no conclusive evidence that this is causative in patients.Case description We present two cases of young adults with chondrolysis of the humeral head after intraarticular pain pump use with humeral head resurfacing and biologic glenoid resurfacing. Literature review Several authors report glenohumeral chondrolysis after shoulder arthroscopy involving the use of bupivacaine pain pumps. In addition, experimental animal studies have confirmed the presence of chondrolysis after bupivacaine infusion. Purposes and clinical relevance These cases provide additional evidence of an important association between postarthroscopic chondrolysis of the glenohumeral joint and the use of bupivacaine pain pumps.

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“…Various case reports showed toxic effects of chlorhexidine on human cartilage after open or arthroscopic surgery. In all cases an unclear or high concentration of chlorhexidine was used for an unknown period of treatment (Bellen 1987, Douw et al 1998, Rombouts et al 1986, Tricoit et al 1984.…”

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confidence: 99%

Comparable Effects of Polyhexanide and Chlorhexidine on Cell Viability of Primary Human Chondrocytes

et al. 2011

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SummaryIn septic orthopaedic surgery, one of the most common used antiseptics is polyhexanide, in contrast to chlorhexidine. Our hypothesis was that the use of low concentrated chlorhexidine has the same toxic effects on human chondrocytes as does treatment with polyhexanide. Human chondrocytes were isolated and cultured and 0.04% polyhexanide, 2% chlorhexidine or 0.1% chlorhexidine were added to the cultures. Toxicity analyses were performed by visualization of cell structure and quantification of LDH activity. Determination of vital chondrocytes was investigated by CellCounter and by fluorescence microscopy. Light microscopic data revealed cell structure defects and change of cell morphology after antiseptic treatment. A significant increase of LDH enzyme activity was shown after treatments with 0.04% polyhexanide and 0.1% chlorhexidine if compared to control. The determination of vital chondrocytes showed a significant decrease. Both antiseptics induce significant cell death of chondrocytes. No significant differences of toxic potential after the treatments with 0.04% polyhexanide and 0.1% chlorhexidine were found.

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Clinical and pathological changes in the knee after accidental chlorhexidine irrigation during arthroscopy: Case reports and review of the literature

Cited by 49 publications

References 6 publications

Human osteoblast damage after antiseptic treatment

Human osteoblast damage after antiseptic treatment

Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps

Comparable Effects of Polyhexanide and Chlorhexidine on Cell Viability of Primary Human Chondrocytes

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