New irrigation solution may reduce infection rates in total joint replacements


Disclosures: Bashyal reports that he is on the speakers bureau and is a paid consultant for Smith & Nephew and Next Science LLC.

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Published results showed that a new irrigation solution had high efficacy against planktonic bacteria and bacterial biofilms in laboratory tests.

“The minimum standard of care for irrigation in orthopedic surgery cases includes normal saline, but a growing body of literature in recent years has suggested that different solutions or additives may be needed to prevent [periprosthetic joint infection] PJI”, Ravi K. Bashyal, MD, lead author of the study, Healio said. “Combating planktonic bacteria and biofilm formation is particularly important given the high negative consequence of developing PJI in the setting of total joint arthroplasty.”

Bashyal and colleagues cultured bacterial strains of microorganisms in an optimal medium and exposed the organisms to fresh irrigating solution (XPerience, Next Science LLC) or phosphate buffered solution for 5 minutes before addition of a neutralizing broth. The researchers determined the colony forming units per milliliter and the log reduction of colony forming units in the treated sample compared to the control sample. The researchers also grew biofilms of microorganisms on glass slides coated with hydroxyapatite and exposed each slide to irrigating solutions for different contact times. The researchers quantified the biofilm and obtained the log10 density of each organism.

Delighted.  K. Bashyal

Ravi K. Bashyal

Results showed six log reductions in planktonic bacteria within 5 minutes and four to eight log reductions in biofilms with the new irrigation solution. According to laboratory tissue tests, the new irrigating solution had minimal cytotoxic effects on host tissues. The researchers noted that this allowed the new irrigating solution to stay in contact with the host without requiring subsequent irrigation, creating a biofilm barrier for up to 5 hours after application.

“An attractive aspect of this irrigant is that it does not require additional irrigation with normal saline after initial application, allowing for additional dwell time of the solution on orthopedic implants and host soft tissues” , wrote the authors. “The compelling in vitro results presented in this study warrant further investigation with appropriate clinical trials to determine the potential ability of this novel irrigant to reduce overall PJI burden.”


Bashyal RK, et al. J Arthroplasty. 2022; doi:10.1016/j.arth.2022.01.045.

A new study reveals that XPerience leave-on solution has persistent efficacy against planktonic bacteria and bacterial biofilms. Published May 10, 2022. Accessed May 16, 2022.

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