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

Springer, Bryan D.

doi:10.1016/j.arth.2022.02.096

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Povidone-iodine achieves broad spectrum bactericidal activity by delivering iodine directly to the cell surface where it enters the cells and oxidizes components of the cytoplasmic membranes. 24 A small number of studies report cytotoxicity, [25][26][27][28] including osteoblasts, myoblasts, chondrocytes, and fibroblasts, with high-concentration P-I use of 1.4%-5%. 29 Although extremely rare, iodine allergies 30,31 may arise from systemic absorption 32 and result in anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Preclosure povidone‐iodine lavage was implemented based on safety and efficacy data from human literature 21–23 as a precautionary measure added to the multimodal approach already in place to minimize PJI in THR cases. Povidone‐iodine achieves broad spectrum bactericidal activity by delivering iodine directly to the cell surface where it enters the cells and oxidizes components of the cytoplasmic membranes 24 . A small number of studies report cytotoxicity, 25–28 including osteoblasts, myoblasts, chondrocytes, and fibroblasts, with high‐concentration P‐I use of 1.4%–5% 29 .…”

Section: Discussionmentioning

confidence: 99%

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Preclosure povidone‐iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis

Israel¹,

Jaramillo²,

Liska³

2022

Veterinary Surgery

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Objective: To report the outcomes and cost-benefit analysis of preclosure povidone-iodine lavage (PrePIL) used to reduce the risk of infection following total hip replacement (THR) surgery.Study design: Retrospective study. Animals: One thousand six hundred ninety-nine dogs, 17 cats. Methods:The medical records of 2213 consecutive THR cases were reviewed to determine the incidence of infection. The last 102 were treated with PrePIL using a commercially sourced 0.035% povidone-iodine solution. Postoperative infection rates were compared. A cost-benefit analysis was used to calculate if a PrePIL protocol is economically feasible.Results: Twenty-one THRs out of 2111 (0.99%) that did not have PrePIL developed infection. Infection occurred in none of the 102 PrePIL cases. Cost analysis revealed a PrePIL break-even cost at $49.74 and a break-even infection rate of 0.949%. No complications were identified related to the use of PrePIL. Conclusion: Preclosure povidone-iodine lavage appeared to be efficacious in lowering THR infection rates, and it appeared to be safe for this use based on our 102 consecutive cases. The cost of the PrePIL was minimal compared to the overall cost to resolve THR infection and the potential effect on hip function prognosis. The math formulas developed can be used by surgeons to calculate cost effectiveness and break-even cost based on their THR infection rate, and to compare to the cost of a THR revision and infection resolution. Clinical significance: At current costs, PrePIL can be used in 2415 THR cases at a similar cost of a single revision surgery and resolution of a periprosthetic infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preclosure povidone‐iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis

Israel¹,

Jaramillo²,

Liska³

2022

Veterinary Surgery

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Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Hammad,

Oktarina,

Suhardi

et al. 2024

Journal Orthopaedic Research

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Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone‐iodine (PI) and hydrogen peroxide (H2O2) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone–implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H2O2, or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull‐out testing. No wound complications were observed. MicroCT scans revealed no differences in peri‐implant trabecular bone parameters. Biomechanical pull‐out testing showed no differences in the bone–implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri‐implant osteocalcin, osterix, or endomucin‐positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity.Clinical RelevanceDilute 0.3% povidone‐iodine and a 1:1 combination of 10% povidone‐iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications.

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Early Periprosthetic Femur Fractures After Primary Cementless Total Hip Arthroplasty: High Risk of Periprosthetic Joint Infection and Subsequent Reoperation

Vasireddi,

Neitzke,

Chandi

et al. 2024

The Journal of Arthroplasty

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

Cited by 3 publications

References 28 publications

Preclosure povidone‐iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis

Preclosure povidone‐iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis

Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model

Early Periprosthetic Femur Fractures After Primary Cementless Total Hip Arthroplasty: High Risk of Periprosthetic Joint Infection and Subsequent Reoperation

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