Hydrogen peroxide in orthopaedic surgery – is it worth the risk?

Abstract

Hydrogen peroxide (HO) is commonly used in orthopaedic surgery during cemented arthroplasty and wound washouts. Its purported roles include antisepsis, haemostasis, mechanical debridement, and optimising the cement-bone interface during cementing. However, despite its apparent harmless mechanism of action, HO has been implicated in fatal and near fatal complications caused through oxygen emboli. We present a case of oxygen embolism and review the existing literature to highlight its potential risks and its lack of therapeutic value. We believe there is little role for its use in orthopaedic surgery.

The role of hydrogen peroxide in hip arthroplasty: A narrative review

“…The former interface however is not affected by hydrogen peroxide use, as by this point in the operation, the hydrogen peroxide solution will have already been used and washed away. Only the cement–bone fixation is strengthened by hydrogen peroxide, aligning with other similar studies, such as an in vitro tensile loading study that achieved better cement fixation when using hydrogen peroxide compared to using normal saline or povidone iodine ( Ackland et al 2009 , Yang et al 2016 ). In conjunction with specific techniques, hydrogen peroxide may show synergy with other antiseptics, such as chlorhexidine and dilute povidone-iodine ( Flemming et al 2016 ).…”

“…As an irrigating solution with effervescence, hydrogen peroxide can mechanically remove tissue debris such as fat, blood and marrow from surface interstices and bony microstructures, which can also increase bony trabeculae porosity ( Ackland et al 2009 , Yang et al 2016 ). This debris removal is also important for preventing infections.…”

“…Of periprosthetic infection in hip arthroplasties, hydrogen peroxide is now commonly used in hip arthroplasties, and its role varies from being used in irrigation, haemostasis and antisepsis to reduction of aseptic loosening and attachment of antibiotics. ( Ackland et al 2009 , Ketonis et al 2009 , Yang et al 2016 ). Hydrogen peroxide’s antiseptic mechanisms are thought to involve deoxyribose nucleic acid (DNA) damage as well as lipid and protein peroxidation, although in vitro illustrations these may differ significantly from the in vivo environment where antimicrobial action may be diluted by regional bodily fluids or the action of catalase that is present in normal human tissue.…”

Hydrogen peroxide: more harm than good?

“…Although the use of hydrogen peroxide in closed cavities is thought to pose a higher risk of oxygen embolus, instances of oxygen embolus have been reported in many other circumstances, including in vascular, 10 orthopaedic, 13 and spinal surgery. 8 In neurosurgery, in addition to systemic oxygen embolus, the use of hydrogen peroxide has resulted in direct neural toxicity, cerebral infarction, and tension pnemocephalus.…”

Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach

“…Based on this limited set of data, there is currently no supportive evidence to recommend H 2 O 2 in the treatment of WON. Moreover, its safety is questionable because several case series reported that its use may be related to embolic events [ 47 – 52 ]. In conclusion, irrigation with H 2 O 2 is currently not advised.…”