Valdés Daniel Alejandro, Minter Jon E
Philadelphia College of Osteopathic Medicine (Georgia), Suwanee, GA, United States.
Northside Hospital, Atlanta, GA, United States.
Front Med (Lausanne). 2024 Jul 2;11:1397192. doi: 10.3389/fmed.2024.1397192. eCollection 2024.
Total joint arthroplasties (TJA) are some of the most commonly performed surgeries in the United States with the number of TJA expected to rise significantly over the next decade as the population ages and arthritic burden worsens. However, the rise in TJA volume correlates with a heightened risk of complications, notably prosthetic joint infections (PJI), despite their low occurrence rate of less than 2%. PJI imposes a significant burden on surgery success, patient well-being, and healthcare costs, with an estimated annual expense of 1.85 billion dollars for hip and knee PJI by 2030. This manuscript delves into the pathophysiology of PJI, exploring our current understanding of the role of bacterial biofilm formation on implanted foreign hardware, providing protection against the host immune system and antibiotics. The article reviews current agents and their efficacy in treating PJI, as well as their cytotoxicity toward native cells involved in wound healing, prompting the exploration of a novel citrate-based solution. The paper highlights the superior properties and efficacy of a novel citrate-based irrigation solution on the treatment and prevention of PJI via increased antimicrobial properties, greater biofilm disruption, increased exposure time, and reduced cytotoxicity compared to conventional solutions, positioning it as a promising alternative. It also provides a perspective on its clinical use in the operating theater, with a step-by-step approach in TJA, whether primary or revisionary.
全关节置换术（TJA）是美国最常进行的手术之一。随着人口老龄化和关节炎负担加重，预计未来十年TJA的数量将大幅上升。然而，尽管TJA的并发症发生率低于2%，但其手术量的增加与并发症风险的升高相关，尤其是假体关节感染（PJI）。PJI给手术成功率、患者健康和医疗成本带来了重大负担，预计到2030年，髋部和膝部PJI的年度费用将达到18.5亿美元。本文深入探讨了PJI的病理生理学，探索了我们目前对细菌生物膜在植入的外来硬件上形成的作用的理解，这种生物膜可保护细菌免受宿主免疫系统和抗生素影响。文章回顾了当前治疗PJI的药物及其疗效，以及它们对参与伤口愈合的天然细胞的细胞毒性，从而促使人们探索一种新型的基于柠檬酸盐的溶液。本文强调了一种新型的基于柠檬酸盐的冲洗溶液在治疗和预防PJI方面的优越特性和疗效，与传统溶液相比，它具有增强的抗菌性能、更强的生物膜破坏能力、更长的暴露时间和更低的细胞毒性，使其成为一种有前途的替代品。文章还提供了其在手术室临床应用的观点，以及在初次或翻修TJA中的分步方法。
