title: Clinical and pathological changes in the knee after accidental chlorhexidine irrigation during arthroscopy. Case reports and review of the literature.
abstract: We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy. All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens. Care is needed in checking irrigation fluids, and these should have a distinctive colour.
authors.affiliation: Department of Pathology, University Hospital Maastricht, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Douw
authors.forename: S K
authors.initials: SK
authors.lastname: Bulstra
authors.forename: J
authors.initials: J
authors.lastname: Vandenbroucke
authors.forename: R G
authors.initials: RG
authors.lastname: Geesink
authors.forename: A
authors.initials: A
authors.lastname: Vermeulen
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001182:Arthroscopy / Q000009:adverse effects*; D002357:Cartilage Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D002710:Chlorhexidine / Q000009:adverse effects*; D004487:Edema / Q000139:chemically induced; D005355:Fibrosis; D006801:Humans; D007592:Joint Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology; D007594:Joint Loose Bodies / Q000139:chemically induced / Q000000981:diagnostic imaging; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D009336:Necrosis; D010007:Osteochondritis / Q000139:chemically induced / Q000473:pathology; D010146:Pain / Q000139:chemically induced; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013585:Synovitis / Q000139:chemically induced / Q000000981:diagnostic imaging; D007507:Therapeutic Irrigation
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine