Effects of Topical Antiseptic Solutions Used During Total Knee Arthroplasty on Suture Tensile Strength

INTRODUCTION: Irrigating a surgical wound with an antiseptic solution is commonly performed while suturing following a total knee arthroplasty (TKA) to help prevent wound complications. The purpose of this study was to: 1) evaluate the mean load to failure of different sutures, and 2) compare the mean load to failure of the sutures after soaking in four different antiseptic solutions. MATERIALS AND METHODS: Load-to-failure tests were conducted on four sets of comparable sutures (eight sutures) from two different companies Ethicon Inc. (Somerville, New Jersey) and Covidien (Mansfield, Massachusetts). The four suture types included: 1) non-absorbable braided polyethylene, 2) absorbable braided glycolide or lactide polymer, 3) absorbable monofilament polydioxanone or polyglyconate, and 4) absorbable monofilament polyglecaprone or gylcomer. Sutures were tested for tensile strength at baseline (i.e., no solution; n=5 per suture), and were then soaked for five minutes in one of four different antiseptic solutions: 0.125% sodium hypochlorite, 4% chlorhexidine gluconate, 10% povidone-iodine, and a 1:1 ratio of 3% hydrogen peroxide and sterile water. Effects of the different solutions on individual sutures were assessed with analysis of variance, and pairwise comparison tests were performed with post-hoc Tukey tests. RESULTS: For the controls, the mean failure loads for the type 1 sutures were 118.5 N and 120.3 N, for the type 2 sutures, 145.8 N and 155.4 N, the type 3 sutures, 103.8 N and 162.2 N, and the type 4 sutures, 86.9 N and 87.7 N. After being soaked in sodium hypochlorite, the mean failure load decreased for one of the type 2 sutures (mean difference, -12.8 N;p=0.003), while the other type 2 suture had a decreased failure load after soaking in povidone-iodine (mean difference, -10.3 N;p=0.041) and hydrogen peroxide (mean difference, -14.6 N;p=0.001). A type 1 suture had an increased load to failure after soaking in povidone-iodine (mean difference, 13.2 N;p<0.0001) and hydrogen peroxide (mean difference, 10.5 N;p<0.0001). CONCLUSION: Certain sutures may have changes in their breaking point depending on what type of antiseptic solution is used for wound irrigation, but due to the small magnitude of change, this may not necessarily be clinically relevant.