BENEFICIAL EFFECTS OF A NOVEL INTRAOPERATIVE SURGICAL IRRIGANT ON POST-OPERATIVE KNEE SWELLING AND LIMB FUNCTION IN PRIMARY TOTAL KNEE ARTHROPLASTY

Abstract

Total knee arthroplasty (TKA) is one of the most common elective orthopedic procedures performed in inpatient and outpatient settings. Swelling, stiffness and pain are common complications that occur after TKA resulting in functional impairment of the joint. Reducing post-operative (PO) inflammation, which consequently helps mitigate edema, swelling and pain, is critical to functional recovery after surgery. This pilot study was designed to evaluate the effects of the intraoperative application of a novel surgical irrigant called XPERIENCE® Advanced Surgical Irrigation (XP), on post TKA lower extremity swelling, joint function, and pain, as part of an all-encompassing swelling reduction regimen. Intraoperative povidone-iodine (PI) application was used as the control. Swelling; an indicator of inflammation, was measured by single frequency-bioimpedance assessment (SF-BIA). Range of motion (ROM) and reliance on ambulatory assistive devices (AAD) were evaluated as indicators of functional recovery. Narcotic consumption for pain management and numerical pain scoring were evaluated as surrogate, limited indicators of quality of life. These parameters were assessed over a period of 6 weeks post index TKA and compared between the control cohort treated intraoperatively with PI and the intervention cohort treated intraoperatively with XP. Intraoperative irrigation with XP resulted in statistically significant improvements in PO swelling at days 7 (p<0.05) and 14 (p<0.01) post index surgery compared to the PI treated control cohort. Statistically significant improvements in ROM at day 7 (p=0.043) and AAD usage at day 21 (p=0.049) were noted in the XP cohort compared to the PI cohort. The XP cohort exhibited a quicker “weaning off opioids” timeline evidenced by the PI cohort reaching half of the maximum percentage of subjects using opioids 8 days later than the XP cohort. There was no statistically significant difference noted in numerical pain scores between the two cohorts. This pilot study signifies the utility of XP as a multifunctional, intraoperative surgical irrigation solution which has demonstrable benefits of reducing PO swelling with the potential to impact functional recovery after TKA.