Abstract
Irrigation and debridement in the treatment of periprosthetic joint infection (PJI) serve an integral role in the eradication of bacterial burden and subsequent re-infection rates. Identifying the optimal irrigation agent, however, remains challenging, as there is limited data on superiority. Direct comparison of different irrigation solutions remains difficult because of variability in treatment protocols. While basic science studies assist in the selection of irrigation fluids, in vitro results do not directly translate into clinical significance once implemented in vivo. Dilute povidone iodine, hydrogen peroxide, chlorhexidine gluconate, acetic acid, sodium hypochlorite, hypochlorous acid, and preformed combination solutions all have potential against a broad spectrum of PJI pathogens with their own unique advantages and disadvantages. Future clinical studies are needed to identify ideal irrigation solutions with optimal bactericidal properties and low cytotoxicity for PJI treatment.
Highlights
Periprosthetic joint infection (PJI) and surgical site infection (SSI) remain common and devastating complications after total joint arthroplasty (TJA) (Sloan et al, 2018)
It should be noted that multiple irrigants are utilized for PJI, the current available antiseptic solutions are not Food and Drug Administration (FDA)-approved, aside from Bactisure, to be used internally and are reserved for external use only. This general overview provides the most up-to-date review of the available literature on irrigation solutions used in PJI
While basic science studies assist in the selection of irrigation fluids, in vitro results do not directly translate into clinical significance once implemented in vivo
Summary
Periprosthetic joint infection (PJI) and surgical site infection (SSI) remain common and devastating complications after total joint arthroplasty (TJA) (Sloan et al, 2018). The iodine itself acts as a potent oxidizer to cell membranes and intracellular components, effectively inactivating proteins, nucleotides, and fatty acids in a concentration-dependent manner. A potent oxidizer that inhibits protein synthesis and essential lipids in the bacterial cell membrane, resulting in its antimicrobial effect. There are no clear guidelines regarding the optimal irrigation type, amount, or protocol for management of acute or chronic PJI The purpose of this comprehensive review is to evaluate commercially available antiseptic irrigation solutions and their clinical outcomes and complications for the management of PJI. Povidone iodine functions as a powerful oxidizer to cell membranes and inactivates intracellular contents in a concentration-dependent method (Ruder and Springer, 2016). Different povidone-iodine concentrations have been tested against various organisms to determine bactericidal activity relative to host cell viability (Ruder and Springer, 2016). PI is commercially available at 100 g/L (10 %), which is both bactericidal and cytotoxic (Ruder and Springer, 2016; Van Meurs et al, 2014)
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