Low-cost dilute povidone betadine soak is ‘ounce of prevention’ against TJR infection
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WAILEA, Hawaii — To avoid the difficulty of treating infected total joint replacements, a speaker said orthopedic surgeons would be wise to use dilute betadine lavage intraoperatively as an “ounce of prevention.”
Dilute povidone betadine lavage is effective and cost-effective, said Thomas P. Schmalzried, MD, who discussed studies that support these claims during a presentation at Orthopedics Today Hawaii.
To make his case in favor of the use of dilute betadine lavage in TJR, Schmalzried, an Orthopedics Today Editorial Board Member, said, “The bugs are getting tougher. That means greater morbidity and mortality. The 1-year weighted mortality rate was 4.2% after total hip periprosthetic joint infection, and 5-year mortality was 21%. Obviously, there’s an associated economic impact. What about an ounce of prevention? I’m talking about dilute betadine lavage.”
He encouraged surgeons to follow a protocol described in a 2012 study by Nicholas M. Brown, MD, and colleagues, in which a 0.35% povidone iodine solution of 12.5 mL of 10% povidone iodine betadine and 500 mL saline was used.
Once the prosthesis components are implanted and just prior to closure, “you do a wound soak for 3 minutes and lavage that away with a liter of saline,” Schmalzried said.
Among 1,862 initial cases, and 688 subsequent cases, of those cases in which infection emerged by 90 days postoperatively, researchers identified 18 infections before dilute betadine use. Investigators found one infection after the solution was used, according to Schmalzried.
“That’s 0.97% rate of infection vs. 0.15%, or a 0.82% reduction. That cost of the betadine solution was $1.11 — 0.058 ounces of betadine per case. That means 1 ounce of betadine treats 17 cases,” he said.
References:
Brown NM, et al. J Arthroplasty. 2012;doi:10.1016/j.arth.2011.03.034.
Editor's Note: The article was updated on July 6, 2021 to clarify details about the 2012 study.
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