Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

Ahmed Siddiqi, Zuhdi E Abdo, Bryan D Springer, Antonia F Chen, Ahmed Siddiqi, Zuhdi E Abdo, Bryan D Springer, Antonia F Chen

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.

Conflict of interest statement

Ahmed Siddiqi is an unpaid consultant for AZ Solutions, LLC; has stock options in ROMTech; and is a paid consultant for Zimmer-Biomet. The Bactisure Wound Lavage solution is discussed in the paper. Zuhdi E. Abdo has no disclosures or conflict of interest. Bryan D. Springer is a board member of the Knee Society, AJRR, AAHKS, Arthroplasty Today, and Journal of Arthroplasty; a paid consultant for Ceramtec, Convatec, Joint Purifications Systems, OsteoRemedies; and receives royalties from Stryker. These are not relevant for this paper. Antonia F. Chen is a board member of AAOS, AJRR, AAHKS, Annals of Joint, CORR, the European Knee Association, Healthcare Transformation ICJR, JOA, JBJI, JBJS, JOR, KSSTA, and MSIS; receives royalties; and is a paid consultant for AMA, Convatec, Ethicon, GLG, Graftworx, Guidepoint, Heraeus, Hyalex, Irrimax, Joint Purification Systems, Pfizer, PhagoMed, Recro, SLACK Incorporated, Sonoran, Stryker, and UpToDate. The Irrisept solution is discussed in the paper.

Copyright: © 2021 Ahmed Siddiqi et al.

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