Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Abstract Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone‐iodine (PI) and hydrogen peroxide (H 2 O 2 ) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone–implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H 2 O 2 , or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull‐out testing. No wound complications were observed. MicroCT scans revealed no differences in peri‐implant trabecular bone parameters. Biomechanical pull‐out testing showed no differences in the bone–implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri‐implant osteocalcin, osterix, or endomucin‐positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity. Clinical Relevance Dilute 0.3% povidone‐iodine and a 1:1 combination of 10% povidone‐iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications.