The Effect of Gentamycin in the Irrigating Solution to Prevent Joint Infection after Anterior Cruciate Ligament (ACL) Reconstruction

Document Type : RESEARCH PAPER

Authors

1 Department of knee Surgery, Bone and Joint Reconstruction Research Center, Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Center for Advanced Orthopaedic Studies at BIDMC - Harvard Medical School, Boston, MA, USA

4 Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, MA, USA

5 Tufts Medical Center, Boston, USA

Abstract

Background: Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture.
Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between
0.14% and 1.8%. Some of the devastating consequences of septic arthritis can encompass hyaline cartilage damage,
arthrofibrosis, and in rare cases amputation. The purpose of this study was to evaluate the effect of gentamicin irrigation
solutions as a process to restrain septic arthritis following arthroscopic ACL reconstruction.
Methods: In this retrospective cohort study, 1464 patients who underwent ACL reconstruction with hamstring tendon
autograft in our institution over 7 years (February 2008 to January 2015) were included. The patients were divided
into two groups based on the type of intra-articular irrigation solution used during the surgery. Patients in Group 1
(Saline) received intra-articular irrigation with normal saline (0.9 % sodium chloride) solution, while those in Group 2
(Gentamycin) received intra-articular irrigation with gentamicin (80 mg/L) added to the normal saline solution. Data
about postoperative infection, its course, management, and outcome were obtained from patients’ records.
Results: Seven patients developed SA, four of whom were from SALINE group (2.2%) and three from Gentamycin
group (0.23%). The incidence rate of SA after arthroscopic ACL reconstruction was significantly lower (P <0.05) when
irrigated with gentamicin solution than merely with saline solution.
Conclusion: Gentamicin irrigation solution has a preservative and protective effect against SA development following
arthroscopic ACL reconstruction. We recommend evaluating this technique as a way in order to depreciate the
prevalence of SA after ACL reconstruction.
Level of evidence: III

Keywords

Main Subjects

References

1. Rybak MJ, Abate BJ, Kang SL, Ruffing MJ, Lerner SA, Drusano GL. Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob Agents Chemother. 1999; 43(7):1549-55.
2. Yazdi H, Kwon JY, Nazarian A, Hafezi P, Ghorbanhoseini M. Staged anatomical reconstruction of MCL using Achilles allograft, a modification to Marx’s technique. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2016;1(2):6-40.
3. Yazdi H, Torkaman A, Ghahramani M, Moradi A, Nazarian A, Ghorbanhoseini M. Short term results of anterior cruciate ligament augmentation in professional and amateur athletes. J Orthop Traumatol. 2017; 18(2):171-6.
4. Torkaman A, Yazdi H, Hosseini MG. The results of single bundle versus double bundle ACL reconstruction surgery, a retrospective study and review of literature. Med Arch. 2016; 70(5):351-3.
5. Schollin-Borg M, Michaelsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy. 2003; 19(9):941-7.
6. Calvo R, Figueroa D, Anastasiadis Z, Vaisman A, Olid A, Gili F, et al. Septic arthritis in ACL reconstruction surgery with hamstring autografts. Eleven years of experience. Knee. 2014; 21(3):717-20.
7. Sonnery-Cottet B, Archbold P, Zayni R, Bortolletto J, Thaunat M, Prost T, et al. Prevalence of septic arthritis after anterior cruciate ligament reconstruction among professional athletes. Am J Sports Med. 2011;39(11):2371-6.
8. Torres-Claramunt R, Pelfort X, Erquicia J, Gil-González S, Gelber PE, Puig L, et al. Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc. 2013;21(12):2844-9.
9. Antoci Jr V, Adams CS, Hickok NJ, Shapiro IM, Parvizi J. Antibiotics for local delivery systems cause skeletal cell toxicity in vitro. Clin Orthop Relat Res. 2007;46(2):200-6.
10. Brophy RH, Wright RW, Huston LJ, Nwosu SK, Spindler KP, MOON Knee Group, et al. Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2015; 97(6):450-4.
11. Katz LM, Battaglia TC, Patino P, Reichmann W, Hunter DJ, Richmond JC. A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy. 2008;24(12):1330-5.
12. Armstrong RW, Bolding F, Joseph R. Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy. 1992; 8(2):213-23.
13. Schuster P, Schulz M, Immendoerfer M, Mayer P, Schlumberger M, Richter J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: evaluation of an arthroscopic graftretaining treatment protocol. Am J Sports Med. 2015;
43(12):3005-12.
14. Cadet ER, Makhni EC, Mehran N, Schulz BM. Management of septic arthritis following anterior cruciate ligament reconstruction: a review of current practices and recommendations. J Am Acad Orthop Surg. 2013; 21(11):647-56.
15. Pérez-Prieto D, Portillo ME, Torres-Claramunt R, Pelfort X, Hinarejos P, Monllau JC. Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated. Knee Surg Sports Traumatol Arthrosc. 2018; 26(2):558-62.
16. Yazdi H, Moradi A, Herbort M. The effect of gentamicin in irrigating solutions on articular infection prophylaxis during arthroscopic ACL reconstruction. Arch Orthop Trauma Surg. 2014; 134(2):257-61.
17. Judd MD, Bottoni LC, Kim D, Burke CM, Hooker MS. Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2006; 22(4): 375-84.
18. Maletis GB, Inacio MC, Reynolds S, Desmond JL, Maletis MM, Funahashi TT. Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med. 2013; 41(8):1780-5.
19. Plante MJ, Li X, Scully G, Brown MA, Busconi BD, DeAngelis NA. Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013; 21(3):696-701.
20. Williams RJ 3rd, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: diagnosis and management. Am J Sports Med. 1997; 25(2):261-7.
21. Indelli PF, Dillingham M, Fanton G, Schurman DJ. Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 2002; 398(2):182-8.
22. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J. Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med. 1999; 27(5):562-70.
23. Burks RT, Friederichs MG, Fink B, Luker MG, West HS, Greis PE. Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med. 2003; 31(3):414-8.
24. Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy. 2009; 25(3):243-9.
25. Fong SY, Tan JL. Septic arthritis after arthroscopic  anterior cruciate ligament reconstruction. Ann Acad Med Singapore. 2004; 33(2):228-34.
26. Malahias MA, Shahpari O, Kaseta MK. The clinical outcome of one-stage high tibial osteotomy and anterior cruciate ligament reconstruction. A current concept systematic and comprehensive review. Arch Bone Joint Surg. 2018; 6(3):161-8.
27. Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2006; 26(6):19-3.
28. Trampuz A, Zimmerli W. Antimicrobial agents in orthopaedic surgery: prophylaxis and treatment. Drugs. 2006;66(8):1089-105.
29. van der Meer JW, van Kasteren M. Improving prescribing in surgical prophylaxis. Antibiotic policies. Boston, MA: Springer; 2005. P. 185-95.
30. Hanssen AD, Spangehl MJ. Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements. Clin Orthop Relat Res. 2004; 427(3):79-85.
31. Nelson CL, McLaren SG, Skinner RA, Smeltzer MS, Thomas JR, Olsen KM. The treatment of experimental osteomyelitis by surgical debridement and the implantation of calcium sulfate tobramycin pellets. J Orthop Res. 2002; 20(4):643-7.
32. Bortnem KD, Wetmore RW, Blackburn GW, Brownell SM. Analysis of therapeutic efficacy, cost, and safety of gentamicin lavage solution in orthopaedic surgery prophylaxis. Orthop Rev. 1990; 19(9):797-801.
33. Lescun TB, Adams SB, Wu CC, Bill RP, Van Sickle DC. Effects of continuous intra-articular infusion of gentamicin on synovial membrane and articular cartilage in the tarsocrural joint of horses. Am J Vet Res. 2002; 63(5):683-7.
34. Nakayama H, Yagi M, Yoshiya S, Takesue Y. Micro-organism colonization and intraoperative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Arthroscopy.2012; 28(5):667-71.
35. Vertullo CJ, Quick M, Jones A, Grayson JE. A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy. 2012; 28(3):337-42.
36. Phegan M, Grayson JE, Vertullo CJ. No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surg Sports Traumatol Arthrosc. 2016; 24(9):2729-35.
37. Syed UA, Seidl AJ, Hoffman RA, Bianchini J, Beredjiklian PK, Abboud JA. Preoperative sterilization preparation of the shoulder: a comparative study evaluating gauze sponge and commercially available applicator prep stick. Arch Bone Joint Surg. 2018; 6(1):34-8.
38. Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med. 1991; 115(8):585-90.
39. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013; 95(9):775-82.
40. Demirağ B, Unal OK, Ozakin C. Graft retaining debridement in patients with septic arthritis after anterior cruciate ligament reconstruction. Acta Orthop Traumatol Turc. 2011; 45(5):342-7.
41. Schulz AP, Götze S, Schmidt HG, Jürgens C, Faschingbauer M. Septic arthritis of the knee after anterior cruciate ligament surgery: stageadapted treatment regimen. Am J Sports Med. 2007;35(7):1064-9.
42. Niebuhr M, Mai U, Kapp A, Werfel T. Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities. Exp Dermatol. 2008; 17(11):953-7.
The Archives of Bone and Joint Surgery
Volume 7, Issue 1
January and February 2019
Pages 67-74

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History

  • Receive Date: 03 May 2018
  • Revise Date: 04 October 2018
  • Accept Date: 21 October 2018

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