Clinical Evidence of Current Irrigation Practices and the Use of Oral Antibiotics to Prevent and Treat Periprosthetic Joint Infection

During total joint arthroplasty, the contamination of the operative field with bacteria has historically been thought to be the major cause of early, acute periprosthetic joint infection (PJI).¹ Aimed at reducing this bacterial load, surgeons have engaged in the use of irrigation and other adjuvants during surgery and prior to wound closure. These additives have varied in type, concentration, and as well as mechanism for disrupting bacterial colonization. Antiseptics, antibiotic-infused irrigation, or soap-like surfactants are three main classifications for irrigation solutions.² Oral antibiotics in the peri- and post-operative period have been explored, while new advances continue to emerge for the prevention and treatment of acute PJI. This review will examine some of the most widely-reported interventions; dilute betadine/povidone-iodine, chlorhexidine and hydrogen peroxide as lavage additives. Techniques for irrigation and extended oral antibiotic regimens will be presented. The role of irrigants in PJI for treatment of planktonic and biofilm bacteria will be discussed. Lastly, the newest advances in the field of adjuvants for prevention of PJI will be presented.