Povidone-Iodine Has a Profound Effect on In Vitro Osteoblast Proliferation and Metabolic Function and Inhibits Their Ability to Mineralize and Form Bone

Ede, Matthew P Newton; Philp, Ashleigh M.; Philp, Andrew; Richardson, Stephen M.; Mohammad, Saeed; Jones, Simon W.

doi:10.1097/brs.0000000000001332

Cited by 21 publications

(13 citation statements)

References 28 publications

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“…Povidone‐Iodine is associated with tissue toxicity. The toxic effects have been reported on various types of tissues, such as skin, brain, lung, joint, etc 10–13 . Even 0.025% PI can make skin fibroblast growth progressively retarded 14 .…”

Section: Introductionmentioning

confidence: 99%

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The Toxicity and Antibacterial Effects of Povidone‐Iodine Irrigation in Fracture Surgery

Wang

Huang

et al. 2022

Orthopaedic Surgery

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Objective Surgical site infection is a common complication of surgery, especially in orthopedics. Povidone‐Iodine (PI) is one of the oldest and most commonly used disinfectants in surgery. However, the toxicity and antimicrobial effect of PI have not been discussed. In addition, no study has explored the optimum PI concentration for sterilization and tissue healing. This study explores the germicidal efficacy of different concentrations PI, in addition, the toxicity and antibacterial effects of PI irrigation in fracture surgery are also discussed. Methods Methicillin‐resistant Staphylococcus aureus and Pseudomonas aeruginosa (P. aeruginosa) were used to evaluate the germicidal efficacy of PI in vitro and in vivo. In vitro, the effects of PI on bacterial growth were analyzed. 2.5%, 1.25%, 0.5%, 0.25%, 0.05%, 0.025%, 0.005%, 0.0025% and 0% PI was added into the bacterial suspension, besides, the bacterial algebra and growth rate were tested. Meanwhile, the fluorescence intensity of viable bacteria was also tested to evaluate the effects of PI on bacterial survival. In vivo, first, femoral fracture with wound infection rat models were established. Second, thyroid gland sections, blood thyroxine, urinary iodine, wound local skin, muscle and bone tissue sections, serum creatinine and alanine aminotransferase, serum and bone local tissue interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), bone morphogenetic protein (BMP‐2), vascular endothelial growth factor (VEGF) and transforming growth factor (TGF‐β1) were detected in rat femoral shaft fracture model with 5%, 2.5%, 0.5%, 0.05%, and 0% PI irrigation. Third, tissue bacteria culture was tested in rat femoral fracture with wound infection model with different concentrations PI irrigation. Results In vitro, 2.5%, 1.25%, 0.5% PI inhibited the growth of bacteria. 1.25%, 0.5% PI killed all the bacteria, while 0.25%, 0.05% PI had not killed bacteria after about 10 min. The iodine absorption of 5%, 2.5%, 0.5% PI irrigation did not cause thyroid injury. The 5%, 2.5%, 0.5% PI irrigation did not make serum creatinine and alanine aminotransferase abnormal and can remove bacteria from wounds. The 0.5%, 2.5% PI irrigation can promote tissue healing and increase BMP‐2, VEGF, TGF‐β1, IL‐10, in addition, decrease IL‐6. 5% PI irrigation would inhibit tissue healing, and increase IL‐6, decrease BMP‐2, VEGF, TGF‐β1, IL‐10. Conclusions Povidone‐Iodine was a widely used disinfectant and 2.5%, 1.25% and 0.5% PI could effectively kill bacteria. Five percent and lower concentration PI irrigation was safe and could not cause thyroid, kidney and liver damage. The 0.5% PI irrigation was beneficial for tissue healing but 5% PI irrigation was the opposite.

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Section: Introductionmentioning

confidence: 99%

“…They used the PI concentrations lower than clinically used and found that 0.01 μM of PI made rat epithelial cells apoptosis, besides, the minimal concentration of PI caused apoptosis was 0.001 μM. Newton et al 13 . put their focus on fracture surgery.…”

Section: Introductionmentioning

confidence: 99%

The Toxicity and Antibacterial Effects of Povidone‐Iodine Irrigation in Fracture Surgery

Wang

Huang

et al. 2022

Orthopaedic Surgery

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“…Newton et al reported the rapid and detrimental effect of PVI on human osteoblast cellular proliferation, metabolic function, and bone nodule mineralization after 0.35% PVI exposed for 3 minutes. 22 Another in vitro study conducted by van Meurs et al 23 reported that only diluted PVI remained bactericidal at a cell-viable concentration, comparing with other antiseptics including hydrogen peroxide, and chlorhexidine digluconate. They concluded that 1.3 g/L (0.13%) diluted PVI could be the optimal antiseptic for intraoperative irrigation.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Povidone Iodine Solution in the Prevention of Surgical Site Infections in Minimally Invasive Instrumented Spinal Fusion Surgery

Lin

Chou

Hsiao

et al. 2020

Global Spine Journal

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Study Design: A retrospective case-controlled study. Objectives: To evaluate overall infection rate and adverse event after harvesting bone graft soaking and surgical wound irrigation by povidone iodine solution (PVI) in the minimally invasive instrumented spinal fusion surgery. In order to reduce the rate of surgical site infection in spinal surgery, surgical wound irrigation by povidone iodine solution has been well-established. However, the efficacy of autologous bone graft soaking by PVI has not been evaluated before. Methods: This is a retrospective cohort study. 120 patients were enrolled in the PVI group and compared with 124 patients in the historical cohort. In the PVI group, the harvesting autologous bone graft was soaking and the surgical wound was also irrigated by diluted PVI solution. The outcome measures were overall infection rate, superficial wound infection and deep infection. In addition, the delayed union of the fusion mass was also evaluated through the radiograph evaluation. Results: Both groups shared similar patient demographics instead of body mass index. The use of PVI solution had decreased the overall infection rate (0% versus 4.03%, p = 0.026) and deep infection rate (0% versus 3.23%, p = 0.047). In addition, there was no delayed bone healing in the PVI group after autologous bone graft soaking. Conclusions: In this study, we conclude that harvested autologous bone graft after PVI soaking in spinal fusion surgery can decrease the incidence of deep infection.

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“…PVI also causes deleterious effects on alkaline phosphatase production and matrix mineralization in a dose-dependent manner [18]. Recent in vitro studies have demonstrated that a higher concentration of PVI (>0.35%) inhibited osteoblast cellular proliferation, metabolic function, and bone nodule mineralization [6] [19]. These negative effects of PVI on osteoblasts resulted in delayed bone union at the cancellous bone osteotomy site.…”

Section: Discussionmentioning

confidence: 99%

“…Povidone-iodine (PVI) irrigation of the surgical field is currently used in urologic, cardiovascular, and orthopedic surgery, since it has been shown to decrease the frequency of postoperative surgical site infections [2] [3]. Although a diluted 1% PVI solution is safe to use on wounds to reduce infection in children with appendicitis [4] and in spinal surgery [5], PVI might have a rapid and detrimental effect on human osteoblast proliferation [6]. However, the effects of PVI on bone healing, especially cancellous bone healing or bone bonding, have not yet been fully elucidated.…”

Section: Introductionmentioning

confidence: 99%

Effects of Povidone-Iodine or Ethanol Exposure on Bone Formation at the Osteotomy Site of the Proximal Tibia in Rats

Nagahata¹,

Miyakoshi²,

Kasukawa³

et al. 2019

OJO

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Background: Povidone-iodine (PVI) irrigation is currently used to decrease the frequency of postoperative surgical site infections. Ethanol (EtOH) is sometimes applied to prevent local recurrence after curettage of benign bone tumors. However, the effects of PVI and EtOH on surrounding soft tissue and on bone union are unclear. The purpose of this study was to determine whether PVI or EtOH adversely affects the cancellous bone healing of the osteotomy site at the proximal tibia in rats. Methods: A cancellous bone osteotomy was performed at the right proximal tibia in 4-month-old, female, Sprague Dawley rats. Vehicle, 10% PVI, or 95% EtOH-soaked gauze was inserted into the osteotomy site and maintained for 6 minutes. The rats were euthanized 2 or 4 weeks after the osteotomy. Results: Two weeks after treatment, the bone union rate was significantly higher in the vehicle group than in the PVI group and the EtOH group (p < 0.001). However, the bone union rate was not significantly different between the PVI and EtOH groups. There was no significant difference among the three groups in the bone union rate 4 weeks after treatment. Conclusion: PVI or EtOH delayed bone union of the cancellous bone osteotomy site of the proximal tibia in the early phase (2 weeks), but not at 4 weeks, in rats.

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Povidone-Iodine Has a Profound Effect on In Vitro Osteoblast Proliferation and Metabolic Function and Inhibits Their Ability to Mineralize and Form Bone

Abstract: NA.

Cited by 21 publications

References 28 publications

The Toxicity and Antibacterial Effects of Povidone‐Iodine Irrigation in Fracture Surgery

The Toxicity and Antibacterial Effects of Povidone‐Iodine Irrigation in Fracture Surgery

Efficacy of Povidone Iodine Solution in the Prevention of Surgical Site Infections in Minimally Invasive Instrumented Spinal Fusion Surgery

Effects of Povidone-Iodine or Ethanol Exposure on Bone Formation at the Osteotomy Site of the Proximal Tibia in Rats

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