Povidone-iodine irrigation used in TKR cases led to reduced SSI rates

DALLAS — Dilute povidone-iodine intraoperative irrigation had the greatest impact on surgical site rates among three stepwise measures instituted to reduce the incidence of surgical site infection among patients undergoing primary total knee replacement, according to a presenter.

Matthew S. Austin

At the American Association of Hip and Knee Surgeons Annual Meeting, Matthew S. Austin, MD, said results of the investigation he and his colleagues conducted showed povidone-iodine irrigation had a significant effect on surgical site infection (SSI) compared to the other two measures they studied, which were skin closure with subarticular monofilament suture and the use of an occlusive dressing.

“We do have a strong signal that intraoperative povidone-iodine irrigation may play the greatest role. It only costs $0.31. There is further preliminary evidence provided by this study that povidone-iodine irrigation may reduce the incidence of SSI, and we would need multicenter trials to definitively prove its efficacy,” Austin said.

The study involved 10,949 primary TKA cases performed between 2006 and 2017, during which the three measures were introduced and used by four surgeons. The primary outcome was SSI within 90 days.

“Over time, our infection rate fell from 2012 to January of 2017,” Austin said about all three measures introduced for the study.

In all, povidone-iodine irrigation was used in 2,124 patients for a 0.24% SSI rate. The monofilament sutures were used in 2,964 patients for a 0.37% SSI rate, and the occlusive dressing was used in 2,411 patients for a 0.33% SSI rate. The 7,665 patients who underwent TKR without receiving any of the three investigated measures had a 0.60% SSI rate.

Austin noted that among the study limitations were that the groups of patients were fairly heterogeneous, and one surgeon used a topical intraoperative wound antibiotic. In addition, the number of patients was relatively small “in each group for a rare complication,” he said. – by Susan M. Rapp

Reference:

Fleischman AN, et al. Paper #15. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 2-5, 2017; Dallas.

Disclosure: Austin reports no relevant financial disclosures.