Povidone-iodine irrigation may not reduce infection risk in TJA
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No decrease occurred in the risk of infection or reoperation for infection when dilute povidone-iodine irrigation was used in primary or revision total hip arthroplasty or total knee arthroplasty cases, published results showed.
“[These results go] against the grain of what many orthopedic surgeons, and particularly hip and knee surgeons, have thought for the last several years,” Kevin I. Perry, MD, co-author of the study and assistant professor of orthopedic surgery at Mayo Clinic, told Orthopedics Today. “It is not to say that [dilute povidone-iodine] certainly does not have an effect, but I think our data suggest that there is no effect. That makes this ripe for a randomized controlled trial at some point,” he said.
In a review of 5,534 primary THA and 6,204 primary TKA procedures performed from 2013 to 2017, Perry and colleagues found 24% of THA cases and 39% of TKA cases involved dilute povidone-iodine irrigation. At 3-month and 1-year follow-ups, Perry noted the researchers found no difference in reoperation rate for infection between patients who received dilute povidone-iodine irrigation and patients who did not.
“We did assess those two groups utilizing a propensity score to see if maybe there were higher-risk patients in each of the groups ... and even with utilizing the propensity score, there was no difference between the two groups,” Perry said.
The researchers also performed a retrospective review of 1,402 revision THA and 1,482 revision TKA cases during the same time period, of which 27% of revision THA cases and 34% of revision TKA cases underwent a dilute povidone-iodine lavage protocol.
“Similarly, we did not find any difference in the revision series for the rate of reoperation at 3 months or 1 year,” Perry said.
However, patients who received the dilute povidone-iodine lavage appeared to have higher hazard ratios, he said.
“What that means is that it looked like the patients who had the betadine lavage had higher rates of reoperation for infection at both 3 months and 1 year,” Perry said. “That certainly goes against what earlier studies have shown,” he said.
Despite the possible risk of selection bias when using povidone-iodine lavage in total joint arthroplasty, Perry said it is possible that povidone-iodine lavage does not have the effect of reducing the risk of infection.
As results of these studies differ from the published literature, Perry noted a randomized controlled trial may help to identify whether povidone-iodine lavage during TJA can reduce the risk of infection.
“It would likely have to be a multicenter randomized, controlled trial and that makes it tricky, as well as just making sure the protocols are the same,” he said. – by Casey Tingle
- References:
- Hart A, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.18.01152.
- Hernandez NM, et al. J Bone Joint Surg Am. 2019;doi:10.2106/JBJS.18.01285.
- For more information:
- Kevin I. Perry, MD, can be reached at 200 1st St. SW, Rochester, MN 55905; email: perry.kevin@mayo.edu.
Disclosure: Perry reports no relevant financial disclosures.