Comparative Analysis of Dilute Povidone Iodine (Betadine) versus Normal Saline in Bilateral Knee Joint Replacement Surgery: A Retrospective Cohort Study
Abstract
Background: One of the proposed methods to reduce the risk of infection after joint replacement is the use of disinfectant solutions at the end of the surgery. Differing results have been reported regarding the effects of diluted povidone-iodine (betadine) washing solution and normal saline in reducing the risk of periprosthetic joint infection (PJI). The purpose of this retrospective cohort study is to compare the outcomes of diluted betadine solution with normal saline in bilateral knee replacement surgery.
Methods: Patients who were referred to Ba’ath Hospital, Hamedan, Iran, from 2019 to 2021 for bilateral knee joint replacement were included. For each patient, one knee was washed with diluted betadine (35%), and the other with normal saline for 3 minutes before closing the wound. Demographic information, risk factors, and the rate of PJI three months after were collected and analyzed.
Results: Out of 320 patients, 177 (55.3%) were women, and the most common underlying disease was type 2 diabetes with a frequency of 20.0%. Out of 640 operated knees, 17 cases (2.7%) of PJI occurred after surgery, of which 11 (4.3%) were washed with normal saline (P = 0.326). The multivariate regression analysis showed that being male (P = 0.028), diabetes (P = 0.030), high blood pressure (P = 0.019), and an increase in each body mass index (BMI) unit (P = 0.030) increased the chance of infection.
Conclusion: Intraoperative irrigation with diluted betadine solution in bilateral knee replacement surgery can reduce the risk of infection, especially in patients with underlying diseases and obesity.
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8. Slullitel PA, Dobransky JS, Bali K, Poitras S, Bhullar RS, Kim PR. Is there a role for preclosure dilute betadine irrigation in the prevention of postoperative infection following total jointarthroplasty? J Arthroplasty. 2020;35(5):1374-8. doi: 10.1016/j.arth.2019.12.035. [PubMed: 31926778].
9. Calkins TE, Culvern C, Nam D, Gerlinger TL, Levine BR, Sporer SM, et al. Dilute betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty: A randomized controlled trial. J Arthroplasty. 2020;35(2):538-43. doi: 10.1016/j.arth.2019.09.011. [PubMed: 31575448].
10. Ruder JA, Springer BD. Treatment of periprosthetic joint infection using antimicrobials: Dilute povidone-iodine lavage.
J Bone Jt Infect. 2017;2(1):10-4. doi: 10.7150/jbji.16448. [PubMed:28529859]. [PubMed Central: PMC5423577].
11. Wood T, Ekhtiari S, Mundi R, Citak M, Sancheti PK, Guerra-Farfan E, et al. The effect of irrigation fluid on periprosthetic joint infection in total hip and knee arthroplasty: A systematic review and meta-analysis. Cureus. 2020;12(4):e7813. doi: 10.7759/cureus.7813. [PubMed: 32467789]. [PubMed Central:PMC7249750].
12. Li C, Ojeda-Thies C, Xu C, Trampuz A. Meta-analysis in periprosthetic joint infection: A global bibliometric analysis. J Orthop Surg Res. 2020;15(1):251. doi: 10.1186/s13018-020-01757-9. [PubMed: 32650802]. [PubMed Central: PMC7350679].
13. Rezapoor M, Parvizi J. Prevention of periprosthetic joint infection. J Arthroplasty. 2015;30(6):902-7. doi:10.1016/j.arth.2015.02.044. [PubMed: 25824026].
14. Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: New guidelines. Bone Joint J. 2017;99-B(4 Supple B): 3-10. doi: 10.1302/0301-620X.99B4.BJJ-2016-1212.R1. [PubMed: 28363888].
15. Siddiqi A, Abdo ZE, Rossman SR, Kelly MA, Piuzzi NS, Higuera CA, et al. what is the optimal irrigation solution in the management of periprosthetic hip and knee joint infections? J Arthroplasty. 2021;36(10):3570-83. doi: 10.1016/j.arth.2021.05.032. [PubMed: 34127346].
16. Martin VT, Zhang Y, Wang Z, Liu QL, Yu B. A systematic review and meta-analysis comparing intrawound vancomycin powder and povidone iodine lavage in the prevention of periprosthetic joint infection of hip and knee arthroplasties. J Orthop Sci. 2022. [Online ahead of print]. doi: 10.1016/j.jos.2022.11.013. [PubMed: 36470703].
17. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: An international registry-based perspective. Arthroplast Today. 2017;3(2):137-40. doi: 10.1016/j.artd.2017.05.003. [PubMed:28695187]. [PubMed Central: PMC5485227].
18. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8 Suppl):61-5. doi: 10.1016/j.arth.2012.02.022. [PubMed: 22554729].
19. Muwanis M, Barimani B, Luo L, Wang CK, Dimentberg R, Albers A. Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty. Arch Orthop Trauma Surg. 2023;143(4):2175-80. doi: 10.1007/s00402-022-04451-z. [PubMed:35488919].
20. Sabah SA, Alvand A, Price AJ. Revision knee replacement for prosthetic joint infection: Epidemiology, clinical outcomes and health-economic considerations. Knee. 2021;28:417-21. doi: 10.1016/j.knee.2020.12.024. [PubMed: 33500184].
21. Koh CK, Zeng I, Ravi S, Zhu M, Vince KG, Young SW. Periprosthetic joint infection is the main cause of failure for
modern knee arthroplasty: An analysis of 11,134 knees. Clin Orthop Relat Res. 2017;475(9):2194-201. doi: 10.1007/s11999-017- 5396-4. [PubMed: 28573549]. [PubMed Central: PMC5539036].
22. Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: A meta-analysis. Int Wound J. 2017;14(3):529-36. doi: 10.1111/iwj.12640. [PubMed: 27397553]. [PubMed Central: PMC7949746].
23. Jamsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, diabetes, and preoperative
hyperglycemia as predictors of periprosthetic joint infection: A single-center analysis of 7181 primary hip and knee
replacements for osteoarthritis. J Bone Joint Surg Am. 2012;94(14):e101. doi: 10.2106/JBJS.J.01935. [PubMed: 22810408].
24. Smyth NA, Kennedy JG, Parvizi J, Schon LC, Aiyer AA. Risk factors for periprosthetic joint infection following total ankle replacement. Foot Ankle Surg. 2020;26(5):591-5. doi: 10.1016/j.fas.2019.07.015. [PubMed: 31427149].
2018;33(10):3238-45. doi: 10.1016/j.arth.2018.05.042. [PubMed:29914821].
2. Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331. doi: 10.1016/j.arth.2014.03.009. [PubMed: 24768547].
3. Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci. 2013;5(1):30-8. doi: 10.4103/0975-7406.106561. [PubMed: 23559821]. [PubMed Central: PMC3612336].
4. Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. Patient-related risk factors for periprosthetic joint infection after totaljoint arthroplasty: A systematic review and meta-analysis.PLoS One. 2016;11(3):e0150866. doi: 10.1371/journal.pone.0150866. [PubMed: 26938768]. [PubMed Central: PMC4777569].
5. Lenguerrand E, Whitehouse MR, Beswick AD, Jones SA, Porter ML, Blom AW. Revision for prosthetic joint infection following hip arthroplasty: Evidence from the National Joint Registry. Bone Joint Res. 2017;6(6):391-8. doi: 10.1302/2046-3758.66.BJR-2017-0003.R1. [PubMed: 28642256]. [PubMed Central: PMC5492333].
6. Gundtoft PH, Pedersen AB, Varnum C, Overgaard S. Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res. 2017;475(11):2623-31. doi: 10.1007/s11999-017-5289-6. [PubMed: 28236084]. [PubMed Central: PMC5638726].
7. Leopold SS. Editor's spotlight/take 5: Increased mortality after prosthetic joint infection in primary THA. Clin Orthop Relat Res. 2017;475(11):2619-22. doi: 10.1007/s11999-017-5478-3. [PubMed: 28840486]. [PubMed Central: PMC5638749].
8. Slullitel PA, Dobransky JS, Bali K, Poitras S, Bhullar RS, Kim PR. Is there a role for preclosure dilute betadine irrigation in the prevention of postoperative infection following total jointarthroplasty? J Arthroplasty. 2020;35(5):1374-8. doi: 10.1016/j.arth.2019.12.035. [PubMed: 31926778].
9. Calkins TE, Culvern C, Nam D, Gerlinger TL, Levine BR, Sporer SM, et al. Dilute betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty: A randomized controlled trial. J Arthroplasty. 2020;35(2):538-43. doi: 10.1016/j.arth.2019.09.011. [PubMed: 31575448].
10. Ruder JA, Springer BD. Treatment of periprosthetic joint infection using antimicrobials: Dilute povidone-iodine lavage.
J Bone Jt Infect. 2017;2(1):10-4. doi: 10.7150/jbji.16448. [PubMed:28529859]. [PubMed Central: PMC5423577].
11. Wood T, Ekhtiari S, Mundi R, Citak M, Sancheti PK, Guerra-Farfan E, et al. The effect of irrigation fluid on periprosthetic joint infection in total hip and knee arthroplasty: A systematic review and meta-analysis. Cureus. 2020;12(4):e7813. doi: 10.7759/cureus.7813. [PubMed: 32467789]. [PubMed Central:PMC7249750].
12. Li C, Ojeda-Thies C, Xu C, Trampuz A. Meta-analysis in periprosthetic joint infection: A global bibliometric analysis. J Orthop Surg Res. 2020;15(1):251. doi: 10.1186/s13018-020-01757-9. [PubMed: 32650802]. [PubMed Central: PMC7350679].
13. Rezapoor M, Parvizi J. Prevention of periprosthetic joint infection. J Arthroplasty. 2015;30(6):902-7. doi:10.1016/j.arth.2015.02.044. [PubMed: 25824026].
14. Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: New guidelines. Bone Joint J. 2017;99-B(4 Supple B): 3-10. doi: 10.1302/0301-620X.99B4.BJJ-2016-1212.R1. [PubMed: 28363888].
15. Siddiqi A, Abdo ZE, Rossman SR, Kelly MA, Piuzzi NS, Higuera CA, et al. what is the optimal irrigation solution in the management of periprosthetic hip and knee joint infections? J Arthroplasty. 2021;36(10):3570-83. doi: 10.1016/j.arth.2021.05.032. [PubMed: 34127346].
16. Martin VT, Zhang Y, Wang Z, Liu QL, Yu B. A systematic review and meta-analysis comparing intrawound vancomycin powder and povidone iodine lavage in the prevention of periprosthetic joint infection of hip and knee arthroplasties. J Orthop Sci. 2022. [Online ahead of print]. doi: 10.1016/j.jos.2022.11.013. [PubMed: 36470703].
17. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: An international registry-based perspective. Arthroplast Today. 2017;3(2):137-40. doi: 10.1016/j.artd.2017.05.003. [PubMed:28695187]. [PubMed Central: PMC5485227].
18. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8 Suppl):61-5. doi: 10.1016/j.arth.2012.02.022. [PubMed: 22554729].
19. Muwanis M, Barimani B, Luo L, Wang CK, Dimentberg R, Albers A. Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty. Arch Orthop Trauma Surg. 2023;143(4):2175-80. doi: 10.1007/s00402-022-04451-z. [PubMed:35488919].
20. Sabah SA, Alvand A, Price AJ. Revision knee replacement for prosthetic joint infection: Epidemiology, clinical outcomes and health-economic considerations. Knee. 2021;28:417-21. doi: 10.1016/j.knee.2020.12.024. [PubMed: 33500184].
21. Koh CK, Zeng I, Ravi S, Zhu M, Vince KG, Young SW. Periprosthetic joint infection is the main cause of failure for
modern knee arthroplasty: An analysis of 11,134 knees. Clin Orthop Relat Res. 2017;475(9):2194-201. doi: 10.1007/s11999-017- 5396-4. [PubMed: 28573549]. [PubMed Central: PMC5539036].
22. Kong L, Cao J, Zhang Y, Ding W, Shen Y. Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: A meta-analysis. Int Wound J. 2017;14(3):529-36. doi: 10.1111/iwj.12640. [PubMed: 27397553]. [PubMed Central: PMC7949746].
23. Jamsen E, Nevalainen P, Eskelinen A, Huotari K, Kalliovalkama J, Moilanen T. Obesity, diabetes, and preoperative
hyperglycemia as predictors of periprosthetic joint infection: A single-center analysis of 7181 primary hip and knee
replacements for osteoarthritis. J Bone Joint Surg Am. 2012;94(14):e101. doi: 10.2106/JBJS.J.01935. [PubMed: 22810408].
24. Smyth NA, Kennedy JG, Parvizi J, Schon LC, Aiyer AA. Risk factors for periprosthetic joint infection following total ankle replacement. Foot Ankle Surg. 2020;26(5):591-5. doi: 10.1016/j.fas.2019.07.015. [PubMed: 31427149].
| Files | ||
| Issue | Vol 10 No 1 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i1.14965 | |
| Keywords | ||
| total knee joint replacement diluted betadine infection around the prosthesis area. | ||
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How to Cite
1.
Shahbazi P, Ghorbani Amjad G. Comparative Analysis of Dilute Povidone Iodine (Betadine) versus Normal Saline in Bilateral Knee Joint Replacement Surgery: A Retrospective Cohort Study. J Orthop Spine Trauma. 2024;10(1):19-24.
