Tyler E Calkins1, Chris Culvern2, Denis Nam2, Tad L Gerlinger2, Brett R Levine2, Scott M Sporer2, Craig J Della Valle2. 1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN. 2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Abstract
BACKGROUND: The purpose of this randomized, controlled trial is to determine whether dilute betadine lavage compared to normal saline lavage reduces the rate of acute postoperative periprosthetic joint infection (PJI) in aseptic revision total knee (TKA) and hip arthroplasty (THA). METHODS: A total of 478 patients undergoing aseptic revision TKA and THA were randomized to receive a 3-minute dilute betadine lavage (0.35%) or normal saline lavage before surgical wound closure. Fifteen patients were excluded following randomization (3.1%) and six were lost to follow-up (1.3%), leaving 457 patients available for study. Of them, 234 patients (153 knees, 81 hips) receivednormal saline lavageand 223 (144 knees, 79 hips) receiveddilute betadine lavage. The primary outcome was PJI within 90 days of surgery with a secondary assessment of 90-day wound complications. A priori power analysis determined that 285 patients per group were needed to detect a reduction in the rate of PJI from 5% to 1% with 80% power and alpha of 0.05. RESULTS: There were eight infections in the saline group and 1 in the betadine group (3.4% vs 0.4%, P = .038). There was no difference in wound complications between groups (1.3% vs 0%, P = .248). There were no differences in any baseline demographics or type of revision procedure between groups, suggesting appropriate randomization. CONCLUSION:Dilute betadine lavage before surgical wound closure in aseptic revision TKA and THA appears to be a simple, safe, and effective measure to reduce the risk of acute postoperative PJI. LEVEL OF EVIDENCE: Level I.
RCT Entities:
BACKGROUND: The purpose of this randomized, controlled trial is to determine whether dilute betadine lavage compared to normal saline lavage reduces the rate of acute postoperative periprosthetic joint infection (PJI) in aseptic revision total knee (TKA) and hip arthroplasty (THA). METHODS: A total of 478 patients undergoing aseptic revision TKA and THA were randomized to receive a 3-minute dilute betadine lavage (0.35%) or normal saline lavage before surgical wound closure. Fifteen patients were excluded following randomization (3.1%) and six were lost to follow-up (1.3%), leaving 457 patients available for study. Of them, 234 patients (153 knees, 81 hips) received normal saline lavage and 223 (144 knees, 79 hips) received dilute betadine lavage. The primary outcome was PJI within 90 days of surgery with a secondary assessment of 90-day wound complications. A priori power analysis determined that 285 patients per group were needed to detect a reduction in the rate of PJI from 5% to 1% with 80% power and alpha of 0.05. RESULTS: There were eight infections in the saline group and 1 in the betadine group (3.4% vs 0.4%, P = .038). There was no difference in wound complications between groups (1.3% vs 0%, P = .248). There were no differences in any baseline demographics or type of revision procedure between groups, suggesting appropriate randomization. CONCLUSION: Dilute betadine lavage before surgical wound closure in aseptic revision TKA and THA appears to be a simple, safe, and effective measure to reduce the risk of acute postoperative PJI. LEVEL OF EVIDENCE: Level I.
Authors: Alec S Kellish; Alisina Shahi; Julio A Rodriguez; Kudret Usmani; Michael Boniello; Ali Oliashirazi; Kenneth Graf; Henry Dolch; David Fuller; Rakesh P Mashru Journal: Arch Bone Jt Surg Date: 2022-06
Authors: Tony S Shen; Alex Gu; Patawut Bovonratwet; Nathaniel T Ondeck; Peter K Sculco; Edwin P Su Journal: Clin Orthop Relat Res Date: 2022-03-01 Impact factor: 4.755
Authors: Benjamin F Ricciardi; Gowrishankar Muthukrishnan; Elysia A Masters; Nathan Kaplan; John L Daiss; Edward M Schwarz Journal: J Orthop Res Date: 2020-01-31 Impact factor: 3.494
Authors: Jason Zlotnicki; Alexandra Gabrielli; Kenneth L Urish; Kimberly M Brothers Journal: Orthop Clin North Am Date: 2021-02-10 Impact factor: 2.472