Irrigation Solutions in Total Joint Arthroplasty

Area of Science:

• Orthopaedic Surgery
• Infectious Diseases
• Biomedical Engineering

Background:

• Prosthetic joint infection (PJI) is a significant complication following total joint arthroplasty.
• PJI presents challenges in eradication, leading to substantial morbidity and mortality.
• Intraoperative irrigation solutions are explored for PJI prevention, but evidence-based guidelines are lacking.

Purpose of the Study:

• To review commonly used intraoperative joint irrigation solutions for prosthetic joint infection (PJI) prevention.
• To evaluate the current literature regarding the efficacy of various irrigation solutions.
• To identify gaps in evidence and guide future research in PJI prophylaxis.

Main Methods:

• Systematic review of clinical literature on intraoperative irrigation solutions for PJI.
• Analysis of studies investigating povidone-iodine, chlorhexidine, acetic acid, hydrogen peroxide, antibiotic irrigations, taurolidine, and polyhexanide-betaine.
• Assessment of evidence quality and consensus on optimal solution and concentration.

Main Results:

• The current literature lacks a clear consensus on the most effective irrigation solution and concentration for PJI prevention.
• No definitive evidence supports one solution over others among the reviewed agents.
• A paucity of high-quality, comparative studies, particularly randomized controlled trials, exists.

Conclusions:

• There is no established evidence-based practice guideline for intraoperative irrigation solutions in preventing PJI.
• Further prospective, randomized controlled trials are necessary to compare the efficacy of different irrigation solutions.
• Comparative studies are crucial to guide clinical decision-making and optimize PJI prevention strategies.