Various prophylaxis methods may not impact 3-month PJI rates, complications after TJA
Key takeaways:
- Vancomycin, povidone-iodine and saline irrigation yielded similar rates of infection and wound complications.
- Outcomes were assessed at 3 months among high-risk patients who underwent hip or knee arthroplasty.
SAN DIEGO — Prophylactic measures such as vancomycin, povidone-iodine and saline irrigation yielded similar rates of periprosthetic joint infection and wound complications at 3 months for high-risk patients undergoing joint arthroplasty.
“We did not find any adverse reactions or any problems using the vancomycin, the [povidone-iodine] or the saline as an irrigation to prevent infections,” Ran Schwarzkopf, MD, MSc, told Healio.
“Our recommendation is for the surgeon to choose every combination that [they] feel comfortable with,” he added.
Schwarzkopf and colleagues performed two multicenter randomized controlled trials that included 821 patients who underwent THA and 1,080 patients who underwent TKA and were deemed high-risk for PJI.
In both studies, patients were randomly assigned to one of four prophylaxis regimens: dilute povidone-iodine lavage alone, topical vancomycin powder alone, a combination of povidone-iodine and vancomycin, and standard saline irrigation alone.
Overall, Schwarzkopf and colleagues found all four cohorts across both studies had similar rates of PJI, septic or aseptic revisions, persistent wound drainage or dehiscence, cellulitis or abscess, and ED visits at 3 months.
“Infection is a constant concern for all surgeons and very morbid for the patient after hip or knee replacement to have a periprosthetic joint infection. We are going to continue and explore different preventive measures to decrease the rate of infection,” Schwarzkopf said. “Looking at different coating for our implants and different supplements and antibiotic regimens after surgery is an ongoing research [topic] and interest for our society.”
References:
- Raymond HE, et al. Paper 188. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
- Raymond HE, et al. Paper 535. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 10-14, 2025; San Diego.
For more information:
Ran Schwarzkopf, MD, MSc, from NYU Langone Health, can be contacted through Marlene Naanes at marlene.naanes@nyulangone.org.
Collapse
Healio Interviews