Evidence review for wound lavage: Joint replacement (primary): hip, knee and shoulder

Excerpt

Wound lavage or irrigation is a washout process routinely used during surgery when performing hip, knee and shoulder replacements. It is used to remove contamination and debris from the site of an operation during the procedure. It is seen as a key part of joint replacement surgery.

In so doing this enables:

1. 1)

   the clinician to have a clear view of the site.

2. 2)

   the exposure and preparation of bone surfaces - allowing the adhesive cement, used in the procedure, to penetrate the bone enabling a solid and lasting fix (of the implant).

3. 3)

   the removal of debris that, potentially, might pass into the blood stream and so to another site in the body.

4. 4)

   a reduction in microbial contamination of the operative site, potentially reducing infection.

The solution used to washout the area of surgery during joint replacement surgery varies; usually influenced by the surgeon’s preference: normal saline, an antiseptic solution or a solution containing antibiotics can be used. However, what is not known is whether the addition of antibiotics and/or antiseptic solutions to the wound lavage fluid help to reduce the risk of infection more effectively than using wound lavage with normal saline solution, alone.

This review focuses on whether antiseptic and/or antibiotic components, when added to the irrigation fluid, are clinically and cost effective when compared to irrigation with saline alone.