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

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

doi:10.1007/s00402-022-04451-z

Cited by 10 publications

(7 citation statements)

References 28 publications

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“…The publication years of the included articles ranged from 2008 to 2023. Among them, 8 articles compared ALBC with negative controls (NC) [ 26 – 33 ], 9 articles compared chlorhexidine bathing with NC [ 34 – 42 ], 4 articles compared povidone iodine lavage with NC [ 14 , 43 – 45 ], and 14 articles compared vancomycin with NC [ 17 , 46 – 58 ]. In addition, 2 articles compared chlorhexidine and povidone iodine bathing [ 16 , 59 ], and 1 article compared povidone iodine bathing, vancomycin powder and NC [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

“…Many randomized controlled trials (RCTs) and cohort studies have been performed to explore preventive strategies to reduce the incidence rate of PJI after TJA, such as applying vancomycin powder [ 13 ], povidone iodine wash [ 14 ], antibiotic-loaded bone cement (ALBC) [ 15 ] and chlorhexidine wash [ 16 ]. However, there are some inconsistencies in their findings.…”

Section: Introductionmentioning

confidence: 99%

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The effect of different preventive strategies during total joint arthroplasty on periprosthetic joint infection: a network meta-analysis

Wu,

Xiang,

2024

J Orthop Surg Res

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Background Periprosthetic joint infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of periprosthetic joint infection. Methods The study protocol was registered at PROSPERO (CRD: 42,023,448,868), and the literature search databases included Web of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE (R) ALL that met the requirements. The network meta-analysis included randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies. Results This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative controls. No improvement was observed in antibiotic-loaded bone cement compared with negative controls. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidone iodine, it still showed a significant difference compared with negative controls. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative controls and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them. Conclusion The study indicated that chlorhexidine, povidone iodine and vancomycin showed significant efficacy in preventing periprosthetic joint infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of different preventive strategies during total joint arthroplasty on periprosthetic joint infection: a network meta-analysis

Wu,

Xiang,

2024

J Orthop Surg Res

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show abstract

“…The publication years of the included articles ranged from 2008 to 2023. Among them, 8 articles compared ALBC with negative control (NC) [23][24][25][26][27][28][29][30], 9 articles compared chlorhexidine bathing with NC [31][32][33][34][35][36][37][38][39], 4 articles compared povidone iodine lavage with NC [40][41][42][43], and 14 articles compared vancomycin with NC [13,[44][45][46][47][48][49][50][51][52][53][54][55][56]]. In addition, 2 articles compared chlorhexidine and povidone iodine bathing [57,58], and 1 article compared povidone iodine bathing, vancomycin powder and NC [59].…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Therefore, nding effective preventive strategies for infection to reduce its occurrence is an urgent issue at present. Many randomized controlled trials (RCTs) and cohort studies have been performed to explore preventive strategies to reduce the incidence rate of SSI or PJI after TJA, such as applying vancomycin powder [9], povidone iodine wash [10], antibiotic-loaded bone cement (ALBC) [11] and chlorhexidine wash [12]. However, there are some inconsistencies in their ndings.…”

Section: Introductionmentioning

confidence: 99%

The effect of different preventive strategies during total joint arthroplasty on surgical site infection: a network meta-analysis

Wu,

Xiang,

2023

Preprint

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BackgroundPeriprosthetic joint infection or surgical site infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of surgical site infection. Methods The study protocol was registered at PROSPERO (CRD: 42023448868), and the literature search databases includedWeb of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE(R) ALL that metthe requirements. The network meta-analysis was performed by using randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection or surgical site infection incidence. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies. The heterogeneity test of direct and indirect evidence was also assessed by R software with the gemtc package. Results This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative control. No improvement was observed in antibiotic-loaded bone cement compared with negative control. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidoneiodine, it still showed a significant difference compared with negative control. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative control and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them. Conclusion The study indicated that chlorhexidine, povidoneiodine and vancomycinshowed significant efficacy in preventing periprosthetic joint infection or surgical site infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.

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“…Kirschbaum et al observed that the likelihood of survival of primary TKA is substantially diminished with each consecutive revision and also that PJI is the principal source of multiple revisions [ 56 ]. Muwanis et al found that dilute povidone-iodine (Betadine, Avrio Health L.P, Stamford, CT, USA) compared with normal saline irrigation is an economical and simple technique to reduce PJI and more specifically SSI in TKA [ 57 ]. According to Buchalter et al, in spite of the utilization of topical irrigation solutions and addition of local antimicrobial agents, the use of a non-cephalosporin perioperative antibiotic (either vancomycin or clindamycin) is related to a higher risk of TKA PJI compared with cefazolin [ 58 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty

Rodríguez-Merchán

Delgado-Martínez

2022

JCM

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Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient’s perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.

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

Cited by 10 publications

References 28 publications

The effect of different preventive strategies during total joint arthroplasty on periprosthetic joint infection: a network meta-analysis

The effect of different preventive strategies during total joint arthroplasty on periprosthetic joint infection: a network meta-analysis

The effect of different preventive strategies during total joint arthroplasty on surgical site infection: a network meta-analysis

Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty

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