{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:19:08Z","timestamp":1787894348000,"version":"build-2784847793"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Septic arthritis is an orthopedic emergency, with the knee being the most commonly affected joint. Standard irrigation with normal saline does not provide biofilm-disrupting efficacy, a key factor in treatment failure, especially against virulent organisms such as\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      and\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      . This study evaluates the use of Hydrocyn, a superoxidized solution with known antibiofilm properties, as an intraoperative joint irrigant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective case series was conducted on 17 adults with native knee septic arthritis from 1 February 2024 to 31 December 2024. All patients underwent standard arthrotomy or arthroscopic washout with joint irrigation using Hydrocyn. Primary outcomes included serial measurement of inflammatory markers, including C-reactive protein (CRP) levels and white blood cell count (WBC), as well as knee range of motion (ROM) at baseline, 1, 2, and 6\u202fweeks; ROM was further assessed up to 12\u202fweeks postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pathogens were identified in 94.1% of cases, including methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA) (17.6%) and\n                      <jats:italic>P. aeruginosa<\/jats:italic>\n                      (11.8%). Significant improvements were observed in CRP levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), WBC (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), and knee ROM (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) at 6\u202fweeks. The reoperation rate due to reinfection was 5.8%. Patients undergoing irrigation more than 24\u202fh after admission demonstrated improvements in outcomes equivalent to those treated within 24\u202fh, with no statistical difference between the groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Superoxide solution irrigation, combined with antibiotics, surgical debridement, and physiotherapy, is associated with excellent clinical outcomes, including rapid normalization of inflammatory markers, functional recovery, and a low reoperation rate. Its potent biofilm-disrupting action may mitigate the adverse effects of delayed surgical intervention, challenging current treatment paradigms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1897673","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:34:56Z","timestamp":1787891696000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Superoxide solution irrigation for septic arthritis: a prospective clinical study of efficacy and a widened therapeutic window"],"prefix":"10.3389","volume":"13","author":[{"given":"Badrul Akmal Hisham Md.","family":"Yusoff","sequence":"first","affiliation":[{"name":"Department of Orthopaedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Farhan Md.","family":"Yusoff","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norlelawati","family":"Mohamad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhamad Karbela Reza","family":"Ramlan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Kamarul Arif","family":"Nik Kamrulzaman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azwan","family":"Aziz Mohamad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic & Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia","place":["Kuala Lumpur, Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e0059","DOI":"10.2106\/JBJS.RVW.19.00059","article-title":"Bacterial septic arthritis of the adult native knee joint: a review","volume":"8","author":"Elsissy","year":"2020","journal-title":"JBJS Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1136\/ard.2006.058909","article-title":"Management of septic arthritis: a systematic review","volume":"84","author":"Mathews","year":"2008","journal-title":"Postgrad Med 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