Novel irrigation solution may reduce infection rates in total joint arthroplasty
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Published results showed a novel irrigation solution had high efficacy against planktonic bacteria and bacterial biofilms in laboratory testing.
“The minimum standard of care for irrigation in orthopedic surgical cases includes normal saline, but an increasing amount of literature in recent years has suggested that different solutions or additives may be needed to prevent [periprosthetic joint infection] PJI,” Ravi K. Bashyal, MD, lead author of the study, told Healio. “Combatting planktonic bacteria and the formation of biofilm is especially important given the high negative consequence of developing a PJI in the total joint arthroplasty setting.”
Bashyal and colleagues grew bacterial strains of microorganisms in optimal medium and exposed the organisms to either a novel irrigation solution (XPerience, Next Science LLC) or phosphate buffer solution for 5 minutes before the addition of a neutralizing broth. Researchers determined the colony-forming units per milliliter and the log reduction in colony-forming units in the treated sample vs. the control sample. Researchers also grew biofilms of microorganisms on hydroxyapatite-coated glass slides and exposed each slide to irrigation solutions for various contact times. Researchers performed biofilm quantification and obtained the log10 density of each organism.
Results showed six-log reductions in planktonic bacteria in 5 minutes and four-log to eight-log reductions in biofilms with the novel irrigation solution. According to laboratory tissue testing, the novel irrigation solution had minimal cytotoxic effects to the host tissue. Researchers noted this allowed for the novel irrigation solution to remain in contact with the host without need for subsequent irrigation, creating a barrier to biofilm for up to 5 hours after its application.
“An attractive aspect of this irrigant is that it does not require additional irrigation with normal saline after initial application, allowing further dwell time of the solution on orthopedic implants and host soft tissues,” the authors wrote. “The compelling in vitro results presented in this study warrant further investigation with appropriate clinical trials to determine potential ability of this novel irrigant to lessen the overall burden of PJI.”
References:
Bashyal RK, et al. J Arthroplasty. 2022;doi:10.1016/j.arth.2022.01.045.
New study finds XPerience no rinse solution has persistent efficacy against both planktonic bacteria and bacterial biofilms. https://www.hmpgloballearningnetwork.com/site/woundcare/news/new-study-finds-xperiencetm-no-rinse-solution-has-persistent-efficacy-against. Published May 10, 2022. Accessed May 16, 2022.
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Ravi K. Bashyal, MD, and colleagues presented the results of a novel irrigation solution that demonstrated high efficacy against both planktonic bacteria and bacterial biofilms in a laboratory testing. The pursuit for the ideal irrigation solution that is meant to remove pathogens in a wound or on orthopedic implants has been underway for more than a century and represents a challenge for both scientists and surgeons.
This novel solution has an intriguing aspect as it does not require additional irrigation with normal saline and can remain in the wound after initial application. The laboratory testing revealed minimal soft tissue toxicity, and this offers an advantage at the time of the application to wound closure and beyond. However, while the results of this laboratory study are encouraging, clinical studies need to be conducted to see if this novel irrigation solution will be the answer to the pursuit of the optimal irrigation solution in the treatment and prevention of periprosthetic joint infection.
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