Review Studies Advance Understanding of the Role of Various Irrigation Solutions in Periprosthetic Joint Infections

Research on pros and cons of different agents is a step toward future evidence-based care


Periprosthetic joint infection (PJI) is a challenging complication of total joint arthroplasty with no “gold standard” diagnostic or therapeutic options.

Although irrigation and debridement play an integral role in eliminating bacteria and preventing re-infection, limited data on the superiority and efficacy of various irrigation agents — combined with in vitro results that do not always directly translate to in vivo outcomes —makes it difficult to optimize care.

Reviewing Literature on Irrigation Solutions to Prevent Joint Infection

Ahmed Siddiqi, D.O., orthopedic surgeon at Hackensack Meridian Health, and colleagues published two review papers studying various irrigation agents for PJI.

The first review paper by Dr. Siddiqi and co-authors, titled “Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections,” was published in Journal of Bone and Joint Infection (JBJI) in May 2021. The paper reviews several antiseptic agents, including:

  • Dilute povidone iodine
  • Hydrogen peroxide
  • Chlorhexidine gluconate
  • Acetic acid
  • Sodium hypochlorite
  • Hypochlorous acid
  • Preformed combination solutions
  • Compilation of Results to Aid in Treatment Guidance

“We wanted to review commercial and on-shelf solutions that all have potential against a broad spectrum of PJI pathogens to determine the pros and cons of each,” said Dr. Siddiqi. “By providing information on outcomes and complications in one article, clinicians will have the most up-to-date data to guide treatment decisions until further research is conducted.”

The second review paper, titled “What is the Optimal Irrigation Solution in the Management of Periprosthetic Hip and Knee Joint Infections?,” was published in Journal of Arthroplasty in July 2021. Dr. Siddiqi and co-authors studied intraoperative antiseptic and non-antiseptic irrigation options in hip and knee joint infections.

Promoting Future Innovation and Research

According to Dr. Siddiqi, these review studies establish a foundation for further research and future best practices in PJI management.

“Because there is no ‘gold standard’ treatment for PJI, additional research, including high-quality in vivo studies, is needed to demonstrate the safety and efficacy of various agents,” said Dr. Siddiqi. “Reviews foster innovation, research and development of future evidence-based protocols for the management of PJI.”

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