Department of Orthopaedic Surgery, University of California, Irvine, Orange, California, USA.
Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA.
Am J Sports Med. 2024 Mar;52(4):1068-1074. doi: 10.1177/03635465241226952. Epub 2024 Feb 14.
Chlorhexidine gluconate (CHG) solution is commonly used as an antiseptic irrigation for bacterial decontamination during orthopaedic surgery. Although the chondrotoxicity of CHG on articular cartilage has been reported, the full extent of CHG-related chondrotoxicity and its effects on the extracellular matrix and mechanical properties are unknown.
To investigate the in vitro effects of a single 1-minute CHG exposure on the viability, biochemical content, and mechanics of native articular cartilage explants.
Controlled laboratory study.
Articular cartilage explants (6 per group) were harvested from femoral condyles of the porcine stifle and sectioned at tidemark. Explants were bathed in CHG solution (0.05% CHG in sterile water) at varying concentrations (0% control, 0.01% CHG, and 0.05% CHG) for 1 minute, followed by complete phosphate-buffered saline wash and culture in chondrogenic medium. At 7 days after CHG exposure, cell viability, matrix content (collagen and glycosaminoglycan [GAG]), and compressive mechanical properties (creep indentation testing) were assessed.
One-minute CHG exposure was chondrotoxic to explants, with both 0.05% CHG (2.6% ± 4.1%) and 0.01% CHG (76.3% ± 8.6%) causing a decrease in chondrocyte viability compared with controls (97.5% ± 0.6%; < .001 for both). CHG exposure at either concentration had no significant effect on collagen content, while 0.05% CHG exposure led to a significant decrease in mean GAG per wet weight compared with the control group (2.6% ± 1.7% vs 5.2% ± 1.9%; = .029). There was a corresponding weakening of mechanical properties in explants treated with 0.05% CHG compared with controls, with decreases in mean aggregate modulus (177.8 ± 90.1 kPa vs 280.8 ± 19.8 kPa; < .029) and shear modulus (102.6 ± 56.5 kPa vs 167.9 ± 16.2 kPa; < .020).
One-minute exposure to CHG for articular cartilage explants led to dose-dependent decreases in chondrocyte viability, GAG content, and compressive mechanical properties. This raises concern for the risk of mechanical failure of the cartilage tissue after CHG exposure.
Clinicians should be judicious regarding the use of CHG irrigation at these concentrations in the presence of native articular cartilage.
葡萄糖酸氯己定（CHG）溶液常用于骨科手术中作为抗菌冲洗液，以去除细菌。尽管已有报道称 CHG 对关节软骨具有软骨毒性，但 CHG 相关软骨毒性的全部程度及其对细胞外基质和机械性能的影响尚不清楚。
研究单次 1 分钟 CHG 暴露对天然关节软骨标本活力、生化含量和力学性能的体外影响。
对照实验室研究。
从猪膝关节股骨髁中采集关节软骨标本（每组 6 个），并在潮标处切取。标本在不同浓度的 CHG 溶液（0.05% CHG 溶于无菌水）中浸泡 1 分钟，然后用完全磷酸盐缓冲盐水冲洗并在软骨形成培养基中培养。CHG 暴露 7 天后，评估细胞活力、基质含量（胶原和糖胺聚糖[GAG]）和压缩力学性能（压痕蠕变试验）。
1 分钟 CHG 暴露对标本具有软骨毒性，0.05% CHG（2.6%±4.1%）和 0.01% CHG（76.3%±8.6%）均导致软骨细胞活力下降，与对照组相比（97.5%±0.6%；均<0.001）。两种浓度的 CHG 暴露均对胶原含量没有显著影响，而 0.05% CHG 暴露导致 GAG 湿重含量与对照组相比显著降低（2.6%±1.7% vs 5.2%±1.9%；=0.029）。与对照组相比，用 0.05% CHG 处理的标本机械性能也相应减弱，平均聚集弹性模量（177.8±90.1kPa 与 280.8±19.8kPa；<0.029）和剪切弹性模量（102.6±56.5kPa 与 167.9±16.2kPa；<0.020）降低。
关节软骨标本 1 分钟暴露于 CHG 可导致细胞活力、GAG 含量和压缩力学性能呈剂量依赖性下降。这引起了对 CHG 暴露后软骨组织机械失效风险的关注。
在存在天然关节软骨的情况下，临床医生应谨慎使用这些浓度的 CHG 冲洗液。
