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Dilute betadine lavage, correcting malnutrition among strategies cited to minimize risk of PJI
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ORLANDO, Fla. — At the Current Concepts in Joint Replacement Winter Meeting, here, Craig J. Della Valle, MD, discussed techniques and considerations to minimize the risk of periprosthetic joint infection.
“My key take home points: Antibiotics are the most important. They do need to be given prior to the surgical incision, and we give them before all of our primary, as well as revision procedures,” Della Valle said. “Host factors are clearly important, as well. From my perspective, I think that educating patients about the risk factors they are bring to you as a surgeon are important. If you can, things like nutrition, poor diabetic control or skin [disorders], trying to optimize those modifiable risk factors preoperatively will probably decrease your risk of infection later on. And, at least in our hands, [dilute] betadine lavage does seem to reduce the infection risk, as well.”
Della Valle also noted surgeons should consider a patient’s nutritional status when developing strategies to minimize infection following joint arthroplasty. In a study of 501 patients who underwent revision arthroplasty, Della Valle and colleagues discovered laboratory parameters for malnutrition, such as albumin and total lymphocyte count, were independent risk factors for infection.
“[Of] the three-quarters of patients who had an aseptic cause of failure, twelve of them developed an infection in the first 90 days postoperatively, which is a 3% risk of infection,” Della Valle said. “Basically, what we found was that patients who had those serum markers of malnutrition were almost six-times as likely to have an acute postoperative infection following an aseptic revision procedure.”
Based on these findings, his group delays surgery in patients who present with these serum markers for malnutrition as they work to correct these nutritional parameters.
Della Valle also highlighted the potential use of dilute betadine lavage to decrease the risk of infection. In their retrospective analysis, Della Valle and colleagues found their patients’ overall infection rate significantly decreased from 0.97% to 0.15% after initiating a protocol that included using 3-minute diluted betadine lavage (20 cc sterile betadine mixed with 500 cc saline) in the wound and painting the skin with betadine prior to wound closure. He noted he and his colleagues have started a randomized trial that prospectively examines the outcomes of this protocol in a revision population. – by Gina Brockenbrough, MA
Reference:
Della Valle CJ. Paper #82. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 9-12, 2015; Orlando, Fla.
Disclosure: Della Valle reports stock options from CD Diagnostics; consulting fees from DePuy Synthes; consulting fees and research funding from Smith & Nephew; research funds from Stryker; and royalties and consulting fees from Zimmer Biomet.