Dilute Povidone-Iodine Irrigation Reduces the Rate of Periprosthetic Joint Infection Following Hip and Knee Arthroplasty: An Analysis of 31,331 Cases

Shohat, Noam; Goh, Graham S.; Harrer, Samantha L.; Brown, Scot

doi:10.1016/j.arth.2021.10.026

Cited by 27 publications

(17 citation statements)

References 34 publications

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“…In a meta-analysis of 8 RCTs, Kobayashi et al identified a significant reduction in rates of PJI with dilute povidone-iodine over saline solution alone 18 . Two other articles, both with large sample sizes, confirmed the benefits of povidone-iodine irrigation 19,20 . In an American Association of Hip and Knee Surgeons (AAHKS) award-winning paper from the 2021 meeting, Premkumar et al also found that dilute povidone-iodine and hydrogen peroxide can eradicate methicillin-susceptible S. aureus (MSSA) biofilm; however, the authors did not find success with saline solution, vancomycin, or bacitracin-polymyxin irrigation 21 .…”

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confidence: 84%

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What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2022

Journal of Bone and Joint Surgery

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Periprosthetic joint infection (PJI) remains the most dreaded complication after total joint arthroplasty (TJA). As reimbursement for joint replacement continues to decline [1][2][3] , fewer orthopaedic surgeons take on this challenging and timeconsuming practice. Indeed, in a recent study, Keely Boyle et al. found that 16% of knee arthroplasty revisions, including revisions for infection, were performed at a different center than the one in which the index procedure was performed. Illgen et al. used the American Joint Replacement Registry (AJRR) to show that, in hips, the migration rate for PJI ranges from 28.6% to 46.6%, depending on the size of the hospital 5 . This places a major portion of the responsibility of PJI care on a few specialized surgeons. Therefore, understanding the economics of PJI care has been a hot topic this year.In a study utilizing the National Inpatient Sample (NIS), Premkumar et al. projected that, by 2030, the annual hospital costs related to PJI of the hip and knee will equal $1.85 billion in the United States 6 . In another study from a single institution, the cost of care for a PJI after a 2-stage total knee arthroplasty (TKA) was more than 5 times the cost of care of an uncomplicated primary TKA for an age-matched and body mass index (BMI)-matched cohor t 7 . Comparing the cost of operative treatment for PJI of the hip and knee with that of aseptic revision, Yao et al. 8 showed that the PJI treatment had costs that were double those of the aseptic treatment. Unintended hospitalization during the 2-stage exchange process was shown to add >$20,000 in costs to patient care, which is concerning because less than one-half of the patients who underwent resection for PJI had a successful 2-stage exchange within 1 year 9 . Using a Markov model, Antonios et al. showed the costeffectiveness of adding a planned second debridement, antibiotics, and implant retention (DAIR) procedure to treat PJI 10 . Efforts to reduce failure in PJI treatment will continue to be an important topic in research. PreventionAlthough originally spoken to Philadelphians to increase fire awareness in the 1700s, Benjamin Franklin's famous quote, "An ounce of prevention is worth a pound of cure," certainly still applies to PJI. With the substantial clinical and financial burden of PJI, resources should be focused, not just on treatment, but on optimizing strategies to prevent infection. Many studies published on this topic at this time will help to guide orthopaedic surgeons and their perioperative management of patients undergoing total hip arthroplasty (THA) and TKA, while prompting more prospective studies to answer important questions.Preoperative Staphylococcus aureus screening is controversial. In a recent systematic review and meta-analysis with 32 studies, Ribau et al. identified a marked reduction in infection with decolonization prior to elective THA and TKA 11 . However, in a randomized controlled trial (RCT) of 613 patients, Rohrer et al. did not find a difference in PJI rates with nasal decolonization, but...

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“…T H E J O U R N A L O F B O N E & JOINT SURGERY d J B J S . O R G VOLUME 104-A d NUMBER 14 d J U LY20, 2022 …”

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confidence: 99%

What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2022

Journal of Bone and Joint Surgery

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“…Its use in combination with vancomycin powder makes it difficult, if not impossible, to differentiate statistically between the effect of vancomycin and the effect of povidone-iodine. 46-49 Specifically, Liao et al 43 reported similar findings strongly in favour of vancomycin powder. However, 46.7% of their results related once again to studies in which it was used in combination with povidone-iodine solutions.…”

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confidence: 87%

Vancomycin powder in total joint replacement

Mancino,

Gant,

Meek

et al. 2023

Bone Joint J

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“…Two recent retrospective propensityematched scoring studies of the Mayo Clinic looking at dilute PI in both primary and revision total hip arthroplasty failed to show any difference in infection rates [6,7]. However, Shoat et al demonstrated a 2.34Â lower rate of PJI in primary hip and knee arthroplasty comparing dilute PI to saline irrigation over a 10-year period from a single institution [8]. One must avoid using dilute PI against native cartilage (eg, unicompartmental knee arthroplasty) because it has the potential to negatively affect chondrocyte viability [9].…”

Section: Povidone Iodinementioning

confidence: 99%

Irrigation Solutions and Antibiotic Powders: Should I Use Them in Primary and Revision Total Joint Arthroplasty?

Springer

2022

The Journal of Arthroplasty

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Dilute Povidone-Iodine Irrigation Reduces the Rate of Periprosthetic Joint Infection Following Hip and Knee Arthroplasty: An Analysis of 31,331 Cases

Cited by 27 publications

References 34 publications

What’s New in Musculoskeletal Infection

What’s New in Musculoskeletal Infection

Vancomycin powder in total joint replacement

Irrigation Solutions and Antibiotic Powders: Should I Use Them in Primary and Revision Total Joint Arthroplasty?

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