Hyperosmolar irrigation compared with a standard solution in a canine shoulder arthroscopy model.
BACKGROUND
A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study.


METHODS
We designed a translational animal model study in which hyperosmolar arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral shoulder arthroscopy. Irrigation fluid was delivered to each shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P <.05.


RESULTS
The mean percentage change in shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant.


CONCLUSIONS
The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during shoulder arthroscopy appears warranted.
Department of Orthopaedics, University of Missouri, Columbia, MO, USA. Electronic address: capiton@health.missouri.edu.
Nicholas M
NM
Capito
Department of Orthopaedics, University of Missouri, Columbia, MO, USA.
Matthew J
MJ
Smith
Department of Orthopaedics, University of Missouri, Columbia, MO, USA.
Aaron M
AM
Stoker
Department of Orthopaedics, University of Missouri, Columbia, MO, USA.
Nikki
N
Werner
Department of Orthopaedics, University of Missouri, Columbia, MO, USA.
James L
JL
Cook
D000818:Animals; D001182:Arthroscopy / Q000379:methods*; D002358:Cartilage, Articular / Q000187:drug effects / Q000473:pathology; D004195:Disease Models, Animal; D004285:Dogs; D007430:Intraoperative Care / Q000379:methods*; D007592:Joint Diseases / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012785:Shoulder Joint / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods
D012462:Saline Solution, Hypertonic
Arthroscopy; canine; chondrocyte viability; extravasation; hyperosmolar; irrigation solution