Diluted Povidone-Iodine Lavage in Total Hip and Knee Replacement: A Retrospective Comparative Study
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Published:
Oct 24, 2022
Keywords:
Joint infection, hip revision, knee revision, iodopovidone, betadine
Main Article Content
Abstract
Introduction: One of the prophylactic techniques to reduce the incidence of periprosthetic infections is dilute povidone-iodine lavage, an agent with bactericidal action against different microorganisms. The purpose of this study was to evaluate the incidence of periprosthetic infections within the first 90 days in patients who had undergone povidone-iodine lavage after implantation of prosthetic components and before wound closure.
Materials and Methods: A comparative retrospective study was performed on patients who had undergone primary total hip or knee replacement due to advanced joint osteoarthritis between October 1999 andApril 2020. We assessed the PJI rate between two cohorts: Group A, which consisted of patients who received povido ne-iodine lavage routinely, and Group B, where this solution was not applied.
Results: 643 (47.60%) knee replacements and 708 (52.40%) hip replacements were performed. When comparing the incidence of periprosthetic infections between both groups, no statistically significant differences were observed (0.92% vs. 0.21%; p = 0.11). However, the risk of infection was increased in the first 90 days after surgery (OR = 4.5; 95% CI 0.56-36.19) when the solution was not used.
Conclusions: The risk of developing periprosthetic infections increased 4.5 times when performing an arthroplasty without irrigation with diluted povidone-iodine. However, this could not be shown to be statistically significant.
Materials and Methods: A comparative retrospective study was performed on patients who had undergone primary total hip or knee replacement due to advanced joint osteoarthritis between October 1999 andApril 2020. We assessed the PJI rate between two cohorts: Group A, which consisted of patients who received povido ne-iodine lavage routinely, and Group B, where this solution was not applied.
Results: 643 (47.60%) knee replacements and 708 (52.40%) hip replacements were performed. When comparing the incidence of periprosthetic infections between both groups, no statistically significant differences were observed (0.92% vs. 0.21%; p = 0.11). However, the risk of infection was increased in the first 90 days after surgery (OR = 4.5; 95% CI 0.56-36.19) when the solution was not used.
Conclusions: The risk of developing periprosthetic infections increased 4.5 times when performing an arthroplasty without irrigation with diluted povidone-iodine. However, this could not be shown to be statistically significant.
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How to Cite
Tillet, F., Bochatey, E., Pérez Alamino, L., & Lopreite, F. A. (2022). Diluted Povidone-Iodine Lavage in Total Hip and Knee Replacement: A Retrospective Comparative Study. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 619-625. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1530
Section
Clinical Research
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18. Cichos KH, Andrews RM, Wolschendorf F, Narmore W, Mabry SE, Ghanem ES. Efficacy of intraoperative
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2019;34(7):S312-8. https://doi.org/10.1016/j.arth.2019.02.002
19. Hernandez NM, Hart A, Taunton MJ, Osmon DR, Mabry TM, Abdel MP, et al. Use of povidone-iodine irrigation
prior to wound closure in primary total hip and knee arthroplasty. J Bone Joint Surg 2019;101(13):1144-50.
https://doi.org/10.2106/JBJS.18.01285
20. Kim C, Kim H, Lee SJ, Yoon JY, Moon J, Lee S, et al. The effect of povidone-iodine lavage in preventing infection
after total hip and knee arthroplasties: Systematic review and meta-analysis. J Arthroplasty 2020;35(8):2267-73.
https://doi.org/10.1016/j.arth.2020.03.004
2. American Joint Replacement Registry. American Joint Replacement Registry 2017 annual report figures. [cited
2019 Jan 17]. http://www.ajrr.net/publications-data/ annual-reports. (Consulta: 17 de enero, 2019)
3. Kapadia BH, Johnson AJ, Hbsc JAD, Issa K, Mont MA. Pre-admission cutaneous chlorhexidine preparation reduces surgical site infections in total hip arthroplasty. J Arthroplasty 2013;28(3):490-3. https://doi.org/10.1016/j.arth.2012.07.015
4. Albuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total joint arthroplasty A
systematic review. J Bone Joint Surg Br 2008;90(7):915-9. https://doi.org/10.1302/0301-620X.90B7.20498
5. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2015;6736(14):1-9. https://doi.org/10.1016/S0140-6736(14)61798-0
6. Springer BD, Cahue S, Etkin CD, Lewallen DG, Mcgrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplasty Today 2017;3(2):137-40. https://doi.org/10.1016/j.artd.2017.05.003
7. Oduwole KO, Glynn AA, Molony DC, Murray D, Rowe S, Holland LM, et al. Anti-biofilm activity of subinhibitory povidone-iodine concentrations against Staphylococcus epidermidis and Staphylococcus aureus. J Orthop
Res 2010;28(9):1252-6. https://doi.org/10.1002/jor.21110
8. Bigliardi PL, Abdul S, Alsagoff L, El-kafrawi HY, Pyon K, Tse C, et al. Povidone iodine in wound healing: A
review of current concepts and practices. Int J Surg 2017;44:260-8. https://doi.org/10.1016/j.ijsu.2017.06.073
9. Hart A, Hernandez NM, Abdel MP, Mabry TM, Hanssen AD, Perry KI. Povidone-iodine wound lavage to prevent
infection after revision total hip and knee arthroplasty. J Bone Joint Surg Am 2019;101(13):1151-9. https://doi.org/10.2106/JBJS.18.01152
10. Brown NM, Cipriano CA, Moric M, Sporer SM, Valle CJ Della. Dilute Betadine lavage before closure for the
prevention of acute postoperative deep periprosthetic joint infection. J Arthroplasty 2012;27(1):27-30. https://doi.
org/10.1016/j.arth.2011.03.034
11. Calkins TE, Culvern C, Nam D, Gerlinger TL, Levine BR, Sporer SM, et al. Dilute Betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty: A randomized controlled trial. J Arthroplasty 2020;35(2):538-41.e1. https://doi.org/10.1016/j.arth.2019.09.011
12. Parvizi J, Gehrke T. Segundo Consenso Internacional sobre Infecciones Musculoesqueléticas. Imaidea In. 2018, pág. 365.
13. Johnson AJ, Kapadia BH, Molina CB, Mont MA, Daley JA. Chlorhexidine reduces infections in knee arthroplasty. J Knee Surg 2013;26(3):213-8. https://doi.org/10.1055/s-0032-1329232
14. Leaper DJ, Surgery E, Edmiston CE, Surgery E. WHO: global guidelines for the prevention of surgical site
infection. J Hosp Infect 2017;95(2):135-6. https://doi.org/10.1016/j.jhin.2016.12.016
15. Driesman A, Shen M, Feng JE, Waren D, Slover J, Bosco J, et al. Perioperative chlorhexidine gluconate wash during joint arthroplasty have equivalent PJI rates in comparison to Betadine wash. J Arthroplasty 2020;35(3):845-8. https://doi.org/10.1016/j.arth.2019.10.009
16. von Keudell A, Canseco JA, Gomoll AH. Deleterious effects of diluted povidone – iodine on articular cartilage. J
Arthroplasty 2013;28(6):918-21. https://doi.org/10.1016/j.arth.2013.02.018
17. Jiranek WA, Waligora AC, Hess SR, Golladay GL. Surgical treatment of prosthetic joint infections of the hip and
knee: Changing paradigms? J Arthroplasty 2015;30(6):912-8. https://doi.org/10.1016/j.arth.2015.03.014
18. Cichos KH, Andrews RM, Wolschendorf F, Narmore W, Mabry SE, Ghanem ES. Efficacy of intraoperative
antiseptic techniques in the prevention of periprosthetic joint infection: Superiority of Betadine. J Arthroplasty
2019;34(7):S312-8. https://doi.org/10.1016/j.arth.2019.02.002
19. Hernandez NM, Hart A, Taunton MJ, Osmon DR, Mabry TM, Abdel MP, et al. Use of povidone-iodine irrigation
prior to wound closure in primary total hip and knee arthroplasty. J Bone Joint Surg 2019;101(13):1144-50.
https://doi.org/10.2106/JBJS.18.01285
20. Kim C, Kim H, Lee SJ, Yoon JY, Moon J, Lee S, et al. The effect of povidone-iodine lavage in preventing infection
after total hip and knee arthroplasties: Systematic review and meta-analysis. J Arthroplasty 2020;35(8):2267-73.
https://doi.org/10.1016/j.arth.2020.03.004