Prosthetic Joint Infection and Wound Leakage After the Introduction of Intraoperative Wound Irrigation With a Chlorhexidine-Cetrimide Solution: A Large-Scale Before-After Study.
Antiseptic solution
Chlorhexidine
Prosthetic joint infection
Total hip replacement
Total knee replacement
Journal
Arthroplasty today
ISSN: 2352-3441
Titre abrégé: Arthroplast Today
Pays: United States
ID NLM: 101681808
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
19
10
2021
revised:
19
09
2022
accepted:
11
10
2022
entrez:
27
2
2023
pubmed:
28
2
2023
medline:
28
2
2023
Statut:
epublish
Résumé
Intraoperative chlorhexidine irrigation could be a valuable additive to systemic antibiotics to prevent infections after total joint arthroplasties. However, it may cause cytotoxicity and impair wound healing. This study evaluates the incidence of infection and wound leakage before and after the introduction of intraoperative chlorhexidine lavage. All 4453 patients receiving a primary hip or knee prosthesis between 2007 and 2013 in our hospital were retrospectively included. They all underwent intraoperative lavage before wound closure. Initially, wound irrigation with 0.9% NaCl was standard care (n = 2271). In 2008, additional irrigation with a chlorhexidine-cetrimide (CC) solution was gradually introduced (n = 2182). Data on the incidence of prosthetic joint infections and wound leakage, as well as relevant baseline and surgical characteristics, were derived from medical charts. Chi-square analysis was used to compare the incidence of infection and wound leakage between patients with and without CC irrigation. Multivariable logistic regression was used to assess robustness of these effects by adjusting for potential confounders. The prosthetic infection rate was 2.2% in the group without CC irrigation vs 1.3% in the group with CC irrigation ( Intraoperative wound irrigation using a CC solution does not seem to affect the risk of prosthetic joint infection or wound leakage. Observational data easily yield misleading results, so prospective randomized studies are needed to verify causal inference. Level III-uncontrolled before and after the study.
Sections du résumé
Background
UNASSIGNED
Intraoperative chlorhexidine irrigation could be a valuable additive to systemic antibiotics to prevent infections after total joint arthroplasties. However, it may cause cytotoxicity and impair wound healing. This study evaluates the incidence of infection and wound leakage before and after the introduction of intraoperative chlorhexidine lavage.
Methods
UNASSIGNED
All 4453 patients receiving a primary hip or knee prosthesis between 2007 and 2013 in our hospital were retrospectively included. They all underwent intraoperative lavage before wound closure. Initially, wound irrigation with 0.9% NaCl was standard care (n = 2271). In 2008, additional irrigation with a chlorhexidine-cetrimide (CC) solution was gradually introduced (n = 2182). Data on the incidence of prosthetic joint infections and wound leakage, as well as relevant baseline and surgical characteristics, were derived from medical charts. Chi-square analysis was used to compare the incidence of infection and wound leakage between patients with and without CC irrigation. Multivariable logistic regression was used to assess robustness of these effects by adjusting for potential confounders.
Results
UNASSIGNED
The prosthetic infection rate was 2.2% in the group without CC irrigation vs 1.3% in the group with CC irrigation (
Conclusions
UNASSIGNED
Intraoperative wound irrigation using a CC solution does not seem to affect the risk of prosthetic joint infection or wound leakage. Observational data easily yield misleading results, so prospective randomized studies are needed to verify causal inference.
Level of Evidence
UNASSIGNED
Level III-uncontrolled before and after the study.
Identifiants
pubmed: 36845287
doi: 10.1016/j.artd.2022.10.003
pii: S2352-3441(22)00230-8
pmc: PMC9947967
doi:
Types de publication
Journal Article
Langues
eng
Pagination
101053Informations de copyright
© 2022 The Authors.
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