Follow-up after arthroplasty of the hip and knee : are we over-servicing or under-caring?

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Abstract

[Indexed for MEDLINE] 12. J Perioper Pract. 2022 Jul-Aug;32(7-8):178-182. doi: 10.1177/1750458921996259. Epub 2021 Jul 11. The role of hydrogen peroxide in hip arthroplasty: A narrative review. Zhou AK(1)(2), Girish M(1)(2), Thahir A(1), An Lim J(1)(2), Tran C(3), Patel S(1)(2), Krkovic M(1). Author information: (1)Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UK. (2)School of Clinical Medicine, University of Cambridge, Cambridge, UK. (3)Department of Medicine, Institute for Society and Genetics, University of California, Los Angeles, USA. Hydrogen peroxide has become more commonly used in hip arthroplasties due to high risk of periprosthetic infections. Its purported roles include irrigation, haemostasis, reduction of aseptic loosening and attachment of antibiotics. However, current literature does not provide conclusive evidence on the efficacy of hydrogen peroxide in preventing aseptic loosening, with some controversy around whether it in fact contributes to aseptic loosening. The complications of hydrogen peroxide across medicine are well distinguished; however, the risks within orthopaedic surgery and hip arthroplasties are not well known. Beyond cytotoxicity, the most dangerous reported risk associated with hydrogen peroxide in hip arthroplasties was an oxygen embolism in an unvented femoral canal and acrylic bone cement, consequentially leading to cardiac arrest. However, it may be inappropriate to solely attribute the oxygen embolism to the use of hydrogen peroxide and thus if used appropriately, hydrogen peroxide may have a justifiable role in hip arthroplasty surgery. In this narrative review, we present the current uses of hydrogen peroxide while evaluating its associated risks. We have summarised the key indications and aggregated recommendations to provide guidelines for the use of hydrogen peroxide in hip arthroplasty. DOI: 10.1177/1750458921996259 PMCID: PMC9240379