Novel Intra- Operative Wound Irrigation Solution to Manage Infection Prevention in Patients Undergoing Primary Joint Arthroplasty: Retrospective Review of a Case Series of 308 Patients
Authors: Jacob Paul B , Justice T. Elaine , Olivo Kristy , Glover Kevin R 
Published: August 2023

Introduction

Periprosthetic joint infection (PJI) after total hip and total knee arthroplasty is a devastating complication that is known to be associated with costly, resource-intensive interventions that place a significant burden on the US healthcare system. Estimated average hospital costs to treat female patients with PJI after total knee arthroplasty (TKA) or total hip arthroplasty (THA) in 2018 was $27,307, and $32,956 respectively. While the average costs to treat male patients with PJI after TKA or THA was $27,097 and $33,090 respectively. One strategy aimed at preventing PJI after total joint arthroplasty is the use of an intra-operative wound irrigation with an antiseptic solution. This retrospective case review was conducted to assess the incidence of PJI after using a novel wound antiseptic irrigation solution in patients undergoing primary TKA and THA.

Methods

The CDC defines surgical site infections, (SSI) as infections that occur after the surgery. The infections are further categorized as superficial involving the skin, or deep tissue. These infections are then divided into; superficial incisional SSI, deep incisional SSI, and organ-space SSI. In a study by Kannan et al., SSIs are more commonly seen in patients with more comorbidities. A consecutive series of 308 high-risk patients undergoing primary TKA or THA between January 4, 2021 and August 30, 2021, in whom Prontosan® Wound Irrigation Solution (B. Braun Medical Inc./ Innovice LLC), containing 0.1% Betaine, a surfactant, and 0.1% Polyhexanide (PHMB) was added to the intra-operative procedure, were evaluated for its impact on the incidence of PJI. The CDC’s Surgical Care Improvement Project, (SCIP) guidelines are standard of care and followed with each surgical procedure. The CDC recommends using antimicrobial prophylaxis at a time before skin incision such that the antibiotic concentration reaches the minimum bactericidal concentration at the time of skin incision, Berríos-Torres SI, et al. All data were prospectively submitted to the American Joint Replacement Registry (AJRR) was retrospectively analyzed to measure the incidence of postoperative infection.

Results

Primary TJA was performed on 308 patients; of these 10 patients were bilateral TKA (205 TKA procedures and 113 THA procedures). The use of Prontosan® Wound Irrigation Solution was associated with zero (0%) incidence of postoperative infection in this population of patients during a 90-day episode of care, nor at any time postoperatively. CMS defines total joint arthroplasty codes as a major surgery, and encounters or procedures within 90 days of the initiating procedure are included in the 90-day episode of care. No patients were lost to follow-up.

Conclusion

There was no incidence of PJI uncovered in this retrospective analysis. Adding Prontosan® Wound Irrigation Solution to the intra-operative protocol, contributed to the absence of PJI in this population and potentially avoided 1.74 female and 1.34 male TKA as well as .95 female and .75 THA resulting in total hospital-avoided costs of $83,824 and $56,126, respectively totaling $139,950.