Revision Arthroplasty: Novel Intraoperative Irrigation Solution to Reduce Infection

Introduction As a major complication of revision arthroplasty, periprosthetic joint infection (PJI) can result in both significant medical morbidity and high economic burden. As such, renewed effort is needed to reduce its occurrence. The aim of this review is to evaluate the impact of a novel intra-operative antiseptic irrigation solution on the incidence of PJI, in patients undergoing revision total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods In a single-arm review, Prontosan® Wound Irrigation Solution (0.1% Betaine, 0.1% Polyhexanide (PHMB), which was previously added to the intra-operative wound irrigation (IOWI) protocol in consecutive patients undergoing revision TKA and THA. Postoperative PJI rates were assessed at ninety days and one year post-surgical appointments. Results A total of 86 revision arthroplasty (72 TKA, 14 THA) patients were enrolled. Thirteen (12 TKA; 1 THA) of the patients presented preoperatively with deep PJI. Within the global 90 day postoperative period, review of postoperative status of two patients were lost to follow-up. Of the remaining patients, in the ninety days after the intra-operative use of Prontosan, none (0/84, 0%) of the remaining revision patients demonstrated signs of infection nor PJI. The one year postoperative evaluation of the remaining revision patients continued to demonstrate no signs or symptoms of infection. Conclusion In a single surgeon, consecutive series of revision hip and knee arthroplasty, use of Prontosan was associated with 0% postoperative infections or PJI in patients undergoing revision arthroplasty. Such findings represent a promising infection-reducing and cost-avoidance solution.