Use of Povidone-Iodine Irrigation Prior to Wound Closure in Primary Total Hip and Knee Arthroplasty An Analysis of 11,738 Cases
These authors identified 5,534 primary THA and 6,204 primary TKA procedures. Cases were grouped on the basis of whether or not the wound was irrigated with 1 L of 0.25% Betadine prior to closure. Betadine irrigation was used in 1,322 (24%) of the THA cases and in 2,410 (39%) of the TKA cases.
The rate of reoperation for infection as assessed at 3 months following THA was similar between those who received dilute PI irrigation (0.9%) and who did not (0.7%) (p = 0.7). At 1 year, the rate of reoperation for infection was similar between those who received dilute PI irrigation (0.7%) and those who did not (0.9%) (p = 0.6). After using the propensity score, there was no difference between the groups in the risk of septic reoperations. For TKA, the rate of reoperation as assessed at 3 months was similar between those who received dilute PI irrigation (0.8%) and those who did not (0.3%) (p = 0.06). At 1 year, there was a greater rate of reoperations for infection among those who received dilute PI irrigation (1.2%) compared with those who did not (0.6%) (p = 0.03). However, there was no difference in the risk of septic reoperations between the groups after using the propensity score.
Povidone-Iodine Wound Lavage to Prevent Infection After Revision Total Hip and Knee Arthroplasty An Analysis of 2,884 Cases
These authors assessed the effectiveness of Betadine irrigation in reducing infection following revision total hips (THA) and and total knees (TKA). Betadine lavage was employed in 27% of the revision THA cases and 34% of the revision TKA cases
Povidone-Iodine Wound Lavage to Prevent Infection After Revision Total Hip and Knee Arthroplasty An Analysis of 2,884 Cases
These authors assessed the effectiveness of Betadine irrigation in reducing infection following revision total hips (THA) and and total knees (TKA). Betadine lavage was employed in 27% of the revision THA cases and 34% of the revision TKA cases
After adjusting for baseline differences between the groups using the propensity-score weighted models, they found no significant difference in the rate of reoperation for infection at 3 months (p = 0.58 for revision THA, and p = 0.06 for revision TKA) and at 12 months (p = 0.78 for revision THA, and p = 0.06 for revision TKA). Nonetheless, the hazard ratios from the propensity-score model trended higher for patients who received Betadine lavage: 1.6 and 1.3 for revision THA at 3 and 12 months, respectively, and 2.9 at both 3 and 12 months for revision TKA.
They noted a trend toward higher rates for reoperation for infection among patients who received PI irrigation.
Comment: These studies do not provide support for the use of Betadine lavage in the prevention of revision for infection in primary or revision total hip and knee arthroplasty. In the discussion they provide evidence of the potential cytotoxic effects of Betadine lavage.
They noted a trend toward higher rates for reoperation for infection among patients who received PI irrigation.
Comment: These studies do not provide support for the use of Betadine lavage in the prevention of revision for infection in primary or revision total hip and knee arthroplasty. In the discussion they provide evidence of the potential cytotoxic effects of Betadine lavage.
The authors do not provide information on the bacteria associated with reoperation for infection in these cases.
While it is recognized that different bacteria are commonly associated with periprosthetic infections of the shoulder, this articles may prompt reconsideration of the use of Betadine lavage.
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