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The Effects of Chlorhexidine Irrigation Solution on Contaminated Bone-Tendon Allografts

Tim Burd, MD, Brian P. Conroy, MD, S. Craig Meyer, MD and William C. Allen, MD

University of Missouri Hospital & Clinics, Department of Orthopaedic Surgery, Columbia, Missouri

Presented at the 24th annual meeting of the AOSSM, Vancouver, British Columbia, Canada, July 1998, the annual meeting of the Musculoskeletal Infection Society, St. Louis, Missouri, August 1998, and the annual meeting of the American Orthopaedic Association, Sun Valley, Idaho, June 1999, where it won the AOA-Zimmer Annual Resident Travel Award.

Address correspondence and reprint requests to Tim Burd, MD, University of Missouri Hospital & Clinics, Department of Orthopaedic Surgery, MC 213, One Hospital Drive, Columbia, MO 65212

The purpose of this study was to determine an expedient and effective method for disinfecting contaminated human bone-tendon allografts. The first part of this study used beef muscle and cadaveric human tissues to determine the most effective solution and volume to decontaminate tissues inoculated with four different organisms: Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Of the solutions tested (benzalkonium chloride, castile soap, castile soap followed by benzalkonium chloride, triple antibiotic, chlorhexidine gluconate, and chlorhexidine gluconate/triple antibiotic), only the 4% chlorhexidine power irrigation solution and 4% chlorhexidine/triple antibiotic bath completely disinfected all tissues. Work in part 2 revealed that a 2% chlorhexidine irrigation solution was equally effective as the 4% solutions. Part 3 of the study involved human Achilles tendon-calcaneus allografts. We found similar results: 3 liters of 2% chlorhexidine power irrigation solution thoroughly removed all microorganisms from the contaminated tissues. All control allografts irrigated with normal saline solution alone revealed positive bacterial growth for all four organisms after 72 hours’ growth on sheep blood agar. Total decontamination time was 10 to 12 minutes. Two percent chlorhexidine irrigation solution may be an effective method for decontaminating human bone-tendon allografts challenged with a polymicrobial inoculum. This method of disinfecting bone-tendon allografts is at least five times more expeditious than methods in previously reported studies.

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