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Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

One of the most important challenges faced by orthopedic surgeons is periprosthetic joint infection (PJI). PJI is a common cause for total joint arthroplasty failure with an incidence of 0.3–1.9%. PJI can be devastating for the patient and extremely costly for the healthcare system. There is concern that a major cause of PJI is intra-operative colonization and recent studies have shown a decrease in PJI with the use of dilute povidone-iodine (Betadine®, Avrio Health L.P, Stamford, CT) irrigation prior to wound closure. This study presents our experience with the use of dilute Betadine® irrigation prior to wound closure and its effect on our post-operative hip and knee arthroplasty acute infection rate.

Materials and methods

Retrospective chart review performed at our hospital looking at PJI amongst patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2013 and 2017 comparing different irrigation methods (n = 3232). The study group (n = 1207) underwent irrigation prior to wound closure with dilute Betadine for 3 min and the control group (n = 1511) underwent irrigation using normal saline (NS).

Results

Using a logistic regression model where the following variables were adjusted for; ASA, age, sex, foley insertion, surgical duration and diabetes mellitus status a statistical significant reduction was seen in any infection (OR 0.45 [0.22; 0.89], p value < 0.05) and SSI (OR 0.30 [0.13; 0.70], p value 0.01) with the Betadine group. No significant reduction was seen with deep infections with the Betadine group compared to the NS group.

Conclusion

PJI is a devastating complication following total joint arthroplasty and we found Betadine compared to NS irrigation provides an inexpensive and simple method to lower any PJI and more specifically SSI in THA and TKA.

Level of evidence

III.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada

    Mashael Muwanis, Bardia Barimani, Lucy Luo, Casey K. Wang, Ronald Dimentberg & Anthony Albers

  2. Department of Orthopaedic Surgery, Taibah University, Madinah, Saudi Arabia

    Mashael Muwanis

  3. McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada

    Bardia Barimani

Authors
  1. Mashael Muwanis
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  2. Bardia Barimani
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Correspondence to Bardia Barimani.

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This research study was conducted retrospectively from data obtained for clinical purposes. We obtained ethical approval through the IRB with St. Mary’s Hospital (McGill University, Canada).

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Muwanis, M., Barimani, B., Luo, L. et al. Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty. Arch Orthop Trauma Surg 143, 2175–2180 (2023). https://doi.org/10.1007/s00402-022-04451-z

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  • DOI: https://doi.org/10.1007/s00402-022-04451-z

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