The Intraoperative Use of Hypochlorous Acid in Infected Hip Arthroplasty Revision Surgery

Abstract

Aim: Arthroplasty infections are serious and difficult to treat complications. Hypochlorous acid (HOCl) is an oxidant produced endogenously in the body as a physiological part of the inflammatory process, with the aim of eliminating pathogens activated by neutrophils. The aim of this study was to evaluate the positive and negative effects on clinical results of HOCl used as an irrigation solution during surgical treatment. Material and Methods: The study included 37 patients who underwent single- or two-stage revision surgery at the University of Health Sciences Şişli Hamidiye Etfal Training and Research Hospital Orthopedics and Traumatology Clinic between January 2017 and December 2021. Treatment was applied according to our standard protocol of irrigation with 450 cc HOCl following implant removal and an additional 50 cc HOCl to the subcutaneous tissue after closing the fascia. The patients were evaluated during follow-up in respect of infections. Results: While single-stage revision surgery applied to 20 patients, two-stage revision surgery applied to 17 patients. 17 (45.9%) of the patients were male and 20 (54.1%) were female with a mean age of 72.8±11.1 years. The mean follow-up period was 25.8±14.1 months. Revision surgery was performed on one patient in each of the single and two-stage surgery groups. A success rate of 94.6% (n=37) was obtained when all patients were evaluated. Conclusion: The HOCl solution can be considered to make a positive contribution to the eradication of infections in revision hip arthroplasty and can be an effective and safe alternative to other irrigation solutions.

Keywords

• Arthroplasty
• Infection
• Hip
• Hypochlorous Acid

Revizyon Yapılan Enfekte Kalça Artroplastilerinde İntraoperatif Hipokloröz Asit Kullanımı

Abstract

Amaç: Artroplasti enfeksiyonları ciddi ve tedavisi güç olan komplikasyonlardır. Hipokloröz asit (hypochlorous acid, HOCl), patojenleri ortadan kaldırmak amacıyla, nötrofiller tarafından aktive edilen inflamatuar sürecin fizyolojik kısmının bir parçası olarak vücutta endojen olarak üretilen bir oksidandır. Bu çalışmanın amacı, cerrahi tedavi sırasında irrigasyon solüsyonu olarak kullanılan HOCl'nin klinik sonuçlar üzerindeki olumlu ve olumsuz etkilerini değerlendirmektir. Gereç ve Yöntemler: Çalışmaya Ocak 2017 ve Aralık 2021 tarihleri arasında Sağlık Bilimleri Üniversitesi Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji kliniğinde tek veya iki aşamalı kalça revizyon cerrahisi geçiren 37 hasta dahil edildi. Tedavi tüm implantlar çıkarıldıktan sonra standart protokolümüze göre 450 cc HOCl ile irrigasyon ve fasya kapatıldıktan sonra subkutan dokuya ek 50 cc HOCl uygulandı. Hastalar takip sırasında enfeksiyonlar açısından değerlendirildi. Bulgular: 20 hastaya tek aşamalı revizyon cerrahisi uygulanırken, 17 hastaya ise iki aşamalı revizyon cerrahisi uygulandı. Hastaların 17'si (%45,9) erkek ve 20'si (%54,1) kadın olup ortalama yaşları 72,8±11,1 yıl idi. Ortalama takip süresi 25,8±14,1 ay idi. Tek ve iki aşamalı cerrahi uygulanan gruplardan ikisinde de birer hastaya revizyon cerrahisi uygulandı. Hastaların tamamı değerlendirildiğinde %94,6'lık (n=37) bir başarı oranı elde edildi. Sonuç: HOCl solüsyonunun revizyon kalça artroplastilerinde enfeksiyonların eradikasyonu açısından olumlu katkılarının olduğu ve diğer irrigasyon solüsyonlarına alternatif olarak etkin ve güvenli bir yıkama solüsyonu olabileceğini öngörmekteyiz.

Keywords

• Artroplasti
• Enfeksiyon
• Kalça
• Hipokloröz Asit

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