The effect of different preventive strategies during total joint arthroplasty on surgical site infection: a network meta-analysis

Abstract

BackgroundPeriprosthetic joint infection or surgical site infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of surgical site infection. Methods The study protocol was registered at PROSPERO (CRD: 42023448868), and the literature search databases includedWeb of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE(R) ALL that metthe requirements. The network meta-analysis was performed by using randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection or surgical site infection incidence. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies. The heterogeneity test of direct and indirect evidence was also assessed by R software with the gemtc package. Results This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative control. No improvement was observed in antibiotic-loaded bone cement compared with negative control. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidoneiodine, it still showed a significant difference compared with negative control. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative control and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them. Conclusion The study indicated that chlorhexidine, povidoneiodine and vancomycinshowed significant efficacy in preventing periprosthetic joint infection or surgical site infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.