Dilute Betadine Lavage Reduces the Risk of Acute Postoperative Periprosthetic Joint Infection in Aseptic Revision Total Knee and Hip Arthroplasty: A Randomized Controlled Trial

Calkins, Tyler E.; Culvern, Chris; Nam, Denis; Gerlinger, Tad L.; Levine, Brett R.; Sporer, Scott M.; Valle, Craig J. Della

doi:10.1016/j.arth.2019.09.011

Cited by 55 publications

(54 citation statements)

References 30 publications

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“…Intraoperative antiseptic prophylactic irrigation solutions have become more popular in the past decade. Recent large‐scale studies have shown some benefit in the use of povidone‐iodine solutions in infection prophylaxis before aseptic revision and primary TJA, however, it has not been consistent across all studies 55–57 . Other irrigants such as chlorhexidine‐gluconate have not been shown to improve infection rates, when compared with current antisepsis protocols 58 …”

Section: New Advancements In Prevention Of Pjimentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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Section: New Advancements In Prevention Of Pjimentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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“…Ultimately, eight studies were selected for inclusion in the qualitative synthesis [8][9][10][17][18][19][20][21]. Two further studies were found by a manual search for a total of 10 studies [7,22]. There was moderate agreement at the title/abstract (k = 0.59, 95% CI: 0.38-0.80) and full text screening stages ( k = 0.90, 95% CI: 0.71-1.00).…”

Section: Study Selectionmentioning

confidence: 99%

“…Among the included studies, one study was an RCT, while the remaining studies were either retrospective cohorts (eight studies) or a case series (one study) [7][8][9][10][17][18][19][20][21][22]. Most studies were published between 2012 and 2019, with one study published in 1990.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Most studies were published between 2012 and 2019, with one study published in 1990. Seven studies focused on primary TJA surgeries and two studies on revision TJA [7][8][9][10][17][18][19][20][21]. One study included all of the above populations without subgroup data presented [20].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Irrigation fluid is a potentially highly cost-effective "frugal innovation" target for the prevention of PJI. Irrigation minimizes bacterial contamination and is often delivered as normal saline alone, or with added concentrations of chlorhexidine or povidone-iodine (Betadine®) [7][8][9]. Both chlorhexidine and Betadine® have bactericidal effects and at appropriate dilution appear safe in terms of wound and tendon healing [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Irrigation Fluid on Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

Wood

Ekhtiari

Mundi

et al. 2020

Cureus

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Introduction Rates of osteoarthritis and total joint arthroplasty (TJA) are on the rise globally. Periprosthetic joint infection (PJI) is the most devastating complication of TJA. A number of different intraoperative interventions have been proposed in an effort to reduce infection rates, including antibiotic cements, local antibiotic powder, and various irrigation solutions. The evidence on the importance of irrigation solutions is limited but has gained prominence recently, including the publication of a large randomized controlled trial (RCT). Thus, the purpose of this study was to evaluate the effectiveness of various irrigation solutions and pressures at reducing the rates of PJI. Methods A systematic review was performed using the electronic databases MEDLINE, Embase, and Web of Science. All records were screened in duplicate. Data collected included basic study characteristics, the details of the intervention and comparison solutions, if applicable, and rates of superficial and deep infection. A meta-analysis of comparative studies was performed to assess for consistency and potential direction of effect. Results A total of ten studies were included, of which one was an RCT, eight were retrospective cohorts, and one was a case series. In total, there were 29,630 TJAs in 29,596 patients. The mean age ranged from 61 to 80 years. Six studies compared povidone-iodine (Betadine®) to normal saline, two studies compared chlorhexidine to saline, one study compared "triple prophylaxis" to standard practice, and one study used gentamicin but had no comparison group. The pooled risk ratio for deep infection in studies using Betadine® compared to saline was 0.62 (95% confidence interval [CI]: 0.33-1.19), while for chlorhexidine it was 0.74 (95%CI: 0.33-1.65).

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Stability analysis of tranexamic acid in the presence of various antiseptic solutions

Heckmann

Chung

Kang

et al. 2022

Journal Orthopaedic Research

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Tranexamic acid (TXA) effectively reduces blood loss and transfusion risk during total joint arthroplasty. Additionally, intraoperative irrigation with various antiseptic solutions is often utilized for the management and prevention of surgical site infection. However, interactions between various antiseptic solutions and TXA have not been investigated. The purpose of this in vitro study is to evaluate the stability of TXA in the presence of common orthopedic antiseptic solutions. Five antiseptic solutions-0.1% chlorhexidine (CHX) gluconate, 10% povidone-iodine (BTD), 0.5% sodium hypochlorite (Dakin's), 3% hydrogen peroxide (H 2 O 2 ), and 1.5% H 2 O 2 -and a 0.9% normal saline (NS) control were obtained. A stock 100 mg/ml TXA solution was diluted in each antiseptic solution to a concentration of 10.0 mg/ml to generate reference standard and stability samples. TXA stability in each solution was measured using high performance liquid chromatography at t = 0 and t = 120 min and reported as mean percent of theoretical concentration (MPT) with associated relative standard deviation (RSD). All experiments were performed in triplicate at room temperature. At t = 0 min, TXA remained stable when mixed with 0.9% NS, 0.1% CHX, 10% BTD, 3% H 2 O 2 , and 1.5% H 2 O 2 (MPT range: 102.0%−105.0%, RSD range: 0.80%−2.92%). Only 0.5% Dakin's led to significant degradation of TXA at t = 0 min (MPT: 14.3%, RSD:1.28%). At t = 120 min, TXA stability persisted for all compounds except Dakin's 0.5% (MPT: 18.4%, RSD: 28.7%). TXA efficacy may be significantly diminished when 0.5% Dakin's is used as an intraoperative irrigation solution. CHX, BTD, and H 2 O 2 do not degrade TXA.

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Dilute Betadine Lavage Reduces the Risk of Acute Postoperative Periprosthetic Joint Infection in Aseptic Revision Total Knee and Hip Arthroplasty: A Randomized Controlled Trial

Cited by 55 publications

References 30 publications

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

The Effect of Irrigation Fluid on Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

Stability analysis of tranexamic acid in the presence of various antiseptic solutions

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