PPJJournal of Perioperative Practice1750-45892515-7949SAGE PublicationsSage UK: London, England10.1177/175045892199625910.1177_1750458921996259Review ArticleThe role of hydrogen peroxide in hip arthroplasty: A narrative reviewhttps://orcid.org/0000-0001-6656-8123ZhouAndrew Kailin12https://orcid.org/0000-0003-0599-5265GirishMilind12ThahirAzeem1https://orcid.org/0000-0003-1610-7956An LimJiang12https://orcid.org/0000-0002-1798-8938TranCaitlyn3https://orcid.org/0000-0003-2657-8874PatelShaan12KrkovicMatija1Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Cambridge, UKSchool of Clinical Medicine, University of Cambridge, Cambridge, UKDepartment of Medicine, Institute for Society and Genetics, University of California, Los Angeles, USAAndrew Kailin Zhou, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK. Email: azhou1998@icloud.com1172021327-8178182© The Author(s) 20212021Association for Perioperative Practicehttps://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Hydrogen peroxide has become more commonly used in hip arthroplasties due to high risk of periprosthetic infections. Its purported roles include irrigation, haemostasis, reduction of aseptic loosening and attachment of antibiotics. However, current literature does not provide conclusive evidence on the efficacy of hydrogen peroxide in preventing aseptic loosening, with some controversy around whether it in fact contributes to aseptic loosening. The complications of hydrogen peroxide across medicine are well distinguished; however, the risks within orthopaedic surgery and hip arthroplasties are not well known. Beyond cytotoxicity, the most dangerous reported risk associated with hydrogen peroxide in hip arthroplasties was an oxygen embolism in an unvented femoral canal and acrylic bone cement, consequentially leading to cardiac arrest. However, it may be inappropriate to solely attribute the oxygen embolism to the use of hydrogen peroxide and thus if used appropriately, hydrogen peroxide may have a justifiable role in hip arthroplasty surgery. In this narrative review, we present the current uses of hydrogen peroxide while evaluating its associated risks. We have summarised the key indications and aggregated recommendations to provide guidelines for the use of hydrogen peroxide in hip arthroplasty.

ArthroplastyHydrogen peroxideProsthesis looseningIrrigationEmbolismtypesetterts1cover-dateJuly/August 2022