Prosthetic Joint Infection and Wound Leakage After the Introduction of Intraoperative Wound Irrigation With a Chlorhexidine-Cetrimide Solution: A Large-Scale Before-After Study

Nienke W Willigenburg; Fatih Yesilkaya; Marijn Rutgers; Dirk Jan F Moojen; Rudolf W Poolman; Diederik H R Kempen

doi:10.1016/j.artd.2022.10.003

Prosthetic Joint Infection and Wound Leakage After the Introduction of Intraoperative Wound Irrigation With a Chlorhexidine-Cetrimide Solution: A Large-Scale Before-After Study

Arthroplast Today. 2022 Nov 28:19:101053. doi: 10.1016/j.artd.2022.10.003. eCollection 2023 Feb.

Authors

Nienke W Willigenburg¹, Fatih Yesilkaya¹, Marijn Rutgers¹, Dirk Jan F Moojen¹, Rudolf W Poolman^{1

2}, Diederik H R Kempen¹

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands.
² Department of Orthopaedic Surgery, LUMC, Leiden, the Netherlands.

Abstract

Background: 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: 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: The prosthetic infection rate was 2.2% in the group without CC irrigation vs 1.3% in the group with CC irrigation (P = .021). Wound leakage occurred in 15.6% of the group without CC irrigation and in 18.8% of the group with CC irrigation (P = .004). However, multivariable analyses showed that both findings were likely due to confounding variables, rather than by the change in intraoperative CC irrigation.

Conclusions: 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: Level III-uncontrolled before and after the study.

Keywords: Antiseptic solution; Chlorhexidine; Prosthetic joint infection; Total hip replacement; Total knee replacement.