AlthoughĬlinical practice guidelines from the WHO and ICM recommend sterile Inactivates intracellular contents in a concentration-dependent Povidone iodine functions as a powerful oxidizer to cell membranes and
Irrigation solutions and their clinical outcomes and complications for the The purpose of thisĬomprehensive review is to evaluate commercially available antiseptic Protocol for management of acute or chronic PJI. No clear guidelines regarding the optimal irrigation type, amount, or Requested withdrawal of bacitracin injections due to high risk ofĪnaphylaxis and complications (FDA, 2020). More recently, the Food and Drug Administration (FDA) has Irrigation in PJI and SSI prevention and treatment (Blom etĪl., 2019). Musculoskeletal infections recommend against the use of antibiotic (NICE), and 2018 international consensus meeting (ICM) on Organization (WHO), National Institute for Health and Care Excellence Management are scarce, the Center for Disease Control (CDC), World Health Table content reproduced with permission from Kavolus et al. (2020).Īlthough high-quality clinical trials exploring surfactant irrigation in PJI HOCl: hypochlorous acid CHG: Chlorhexidine gluconate. MOA: mechanism of action EPS: extracellular polymeric substances Identifying the ideal irrigation solution remainsĬhallenging, however, as there is limited data on superiority. Sodium hypochlorite, acetic acid, hypochlorous acid, and combination Povidone iodine, chlorhexidine gluconate (CHG), hydrogen peroxide, Antibiotic irrigation most commonlyĬontains bacitracin and/or polymyxin. Surfactants contain detergents, such asĬastile soap or benzalkonium chloride. Additives are divided into three categories: surfactants,Īntibiotics, and antiseptics. Irrigation solution should have minimal toxicity while maintainingīactericidal and fungicidal activity at its minimum biofilm eradicationĬoncentration (MBEC), which is defined as the lowest concentration needed to The use of multiple additives with normal saline solution irrigation to improve bacterial bioburden eradication is Tissue remains the most critical portion of any of the surgical options for However, thorough irrigation and debridement of infectious Revision arthroplasty may be considered in certain situations in effort toĭecrease morbidity and mortality associated with additional surgical
Two-stage revision arthroplasty is considered the gold standard treatmentįor PJI, debridement, antibiotics, and implant retention (DAIR) as well as one-stage
Remain common and devastating complications after total joint arthroplasty Periprosthetic joint infection (PJI) and surgical site infection (SSI) Identify ideal irrigation solutions with optimal bactericidal properties and Sodium hypochlorite, hypochlorous acid, and preformed combination solutionsĪll have potential against a broad spectrum of PJI pathogens with their own Povidone iodine, hydrogen peroxide, chlorhexidine gluconate, acetic acid, Translate into clinical significance once implemented in vivo. While basic science studiesĪssist in the selection of irrigation fluids, in vitro results do not directly However, remains challenging, as there is limited data on superiority.ĭirect comparison of different irrigation solutions remains difficultīecause of variability in treatment protocols. Identifying the optimal irrigation agent, (PJI) serve an integral role in the eradication of bacterial burden and Irrigation and debridement in the treatment of periprosthetic joint infection
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