Superoxide solution irrigation for septic arthritis: a prospective clinical study of efficacy and a widened therapeutic window

Background 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 Staphylococcus aureus and Pseudomonas aeruginosa . This study evaluates the use of Hydrocyn, a superoxidized solution with known antibiofilm properties, as an intraoperative joint irrigant. Methods 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 weeks; ROM was further assessed up to 12 weeks postoperatively. Results Pathogens were identified in 94.1% of cases, including methicillin-resistant Staphylococcus aureus (MRSA) (17.6%) and P. aeruginosa (11.8%). Significant improvements were observed in CRP levels ( p < 0.001), WBC ( p = 0.001), and knee ROM ( p < 0.001) at 6 weeks. The reoperation rate due to reinfection was 5.8%. Patients undergoing irrigation more than 24 h after admission demonstrated improvements in outcomes equivalent to those treated within 24 h, with no statistical difference between the groups. Conclusion 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.