title: Hydrogen peroxide in orthopaedic surgery - is it worth the risk?
abstract: Hydrogen peroxide (H2O2) 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, H2O2has 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.
authors.affiliation: a Department of Orthopaedics , Launceston General Hospital , Tasmania , Australia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: b Department of Anaesthetics , Launceston General Hospital , Tasmania , Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Reid
authors.affiliation: c Department of Surgery (RMH) , The University of Melbourne , Victoria , Australia.
authors.forename: Mithun
authors.initials: M
authors.lastname: Nambiar
authors.affiliation: a Department of Orthopaedics , Launceston General Hospital , Tasmania , Australia.
authors.forename: David
authors.initials: D
authors.lastname: Penn
mesh_terms: D000890:Anti-Infective Agents / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D004618:Embolism, Air / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006861:Hydrogen Peroxide / Q000009:adverse effects*; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods; D056888:Patient Positioning; D011475:Prosthesis Failure; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000009:adverse effects
chemical_list: D000890:Anti-Infective Agents; D006861:Hydrogen Peroxide
keywords: Arthroplasty; cement; hydrogen peroxide; oxygen embolism