Abstract
Objectives:
Chlorhexidine gluconate (CHG) is commonly used in antiseptic irrigation solutions for bacterial decontamination during orthopaedic surgery. Although the chondrotoxicity of CHG to articular cartilage has been reported, CHG irrigation is utilized by some surgeons to limit surgical site infection and to salvage grafts after accidental contamination during joint surgery. The full extent of CHG irrigation-related chondrotoxicity, as well as its effects on articular cartilage extracellular matrix and mechanical properties, are unknown. The purpose of this study was to determine the in vitro effects of a single one-minute CHG exposure on the viability, biochemical content, and mechanics of native articular cartilage explants.
Methods:
Articular cartilage explants (n=6 per group) were harvested from the femoral condyles of the porcine stifle and sectioned at the tidemark. Explants were bathed in Irrisept® chlorhexidine solution (0.05% CHG in sterile water) at varying concentrations (0% control, 0.01% CHG, and 0.05% CHG) to stimulate surgical irrigation for 1 minute, followed by complete phosphate-buffered saline wash and culture. After seven days of culture in chondrogenic medium, the explants were analyzed for viability (live/dead assay); collagen content (hydroxyproline assay); glycosaminoglycan (GAG) content (dimethyl methylene blue assay); and compressive mechanical testing (creep indentation testing). Statistical analyses were performed using a one-way ANOVA with post hoc Tukey test.
Results:
Seven days after CHG exposure, a dose-dependent decrease in mean chondrocyte viability was observed in the CHG groups (p<0.001), with <3% viability observed in the 0.05% CHG group (Figure 1). There was no significant difference in mean collagen content per wet weight among groups. Conversely, 0.05% CHG exposure led to a decrease in mean GAG per wet weight compared to negative control (p=0.029) and 0.01% CHG (p=0.046) (Figure 2). These changes in GAG content corresponded to observed changes in the compressive mechanical properties of the explants. A dose-dependent decrease in mean aggregate modulus and shear modulus was observed after CHG exposure (p<0.029), indicating weakening of the cartilage matrix and increased deformation in response to compressive loads (Figure 3).
Conclusions:
One-minute CHG exposure to articular cartilage explants led to dose-dependent decreases in chondrocyte viability, GAG content, and compressive mechanical properties. These detrimental effects were observed for both 0.05% and 0.01% CHG concentrations. There is a paucity of literature examining the effects of CHG on articular cartilage matrix and mechanics, and the findings of this study suggest a lack of matrix maintenance following cell death, raising concern for risk of mechanical failure of the cartilage tissue. Clinicians should be judicious regarding the use of CHG irrigation at these concentrations in the presence of native articular cartilage.
