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Toxic effects of wound irrigation solutions on cultured tibiae and osteoblasts
K K Kaysinger1, N C Nicholson, W K Ramp
1Baxter Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
Abstract:
Irrigating wounds with solutions of antiseptic or antibiotic agents is routinely performed in orthopaedic surgery to reduce the incidence of microbial infection. The effects of these agents on healthy bone tissue is unknown. Three commonly employed antiseptic agents (hydrogen peroxide, Betadine solution, Betadine scrub) and one antibiotic solution (bacitracin) were tested on tibiae and osteoblasts isolated from embryonic chicks. Osteoblast function was evaluated by glycolytic energy metabolism (lactate production), cell number (DNA content), and collagen synthesis ([3H]proline hydroxylation). Two series of experiments were performed. To study concentration-related effects, tibiae or cells were exposed to a range of concentrations of the agents (diluted in saline, 0.9% NaCl) for 2 min, rinsed with saline, and incubated for 24 h in medium containing [3H]proline. For the recovery study, the cells were exposed to an effective, but nonlethal, concentration of the antiseptic agents for 2 min, rinsed with saline, and the incubation was continued in complete culture medium for 6, 12, 24, 48, or 72 h with [3H]proline added for the final 6 h. Solutions containing the antiseptic agents were cytotoxic to both bones and cells at concentrations well below those used clinically in irrigation solutions. In contrast, bacitracin at the concentrations tested was safe for osteoblasts and tibiae. These results suggest that the use of irrigation solutions containing H2O2, Betadine solution, or Betadine scrub on exposed bone tissue should be considered with caution.
Insights
Commonly used antiseptic solutions like hydrogen peroxide and Betadine can harm bone cells and tissue at concentrations below clinical use. Antibiotic bacitracin, however, proved safe for osteoblasts and bone in this study.
Area of Science:
- Orthopaedic Surgery
- Biomaterials Science
- Cell Biology
Background:
- Wound irrigation with antiseptic or antibiotic solutions is standard in orthopaedic surgery to prevent infection.
- The impact of these agents on healthy bone tissue remains largely uninvestigated.
Purpose of the Study:
- To evaluate the cytotoxic effects of common antiseptic and antibiotic agents on bone tissue and osteoblasts.
- To determine the safety and efficacy of these agents in orthopaedic wound management.
Main Methods:
- Tested hydrogen peroxide, Betadine solution, Betadine scrub, and bacitracin on chick embryonic tibiae and osteoblasts.
- Assessed osteoblast function via metabolic activity, cell count, and collagen synthesis.
- Conducted concentration-response and cell recovery experiments.
Main Results:
- Antiseptic agents (H2O2, Betadine) exhibited cytotoxicity to bone and cells at sub-clinical concentrations.
- Bacitracin demonstrated safety for osteoblasts and bone at tested concentrations.
- Antiseptic agents showed significant negative effects on osteoblast function.
Conclusions:
- Clinical use of H2O2, Betadine solution, or Betadine scrub for bone irrigation warrants caution due to potential cytotoxicity.
- Bacitracin presents a safer alternative for bone irrigation in orthopaedic procedures.
- Further research into biocompatible wound irrigation solutions is recommended.