Research Articles

Comparison of the use of two washing solutions (diluted betadine and normal saline serum) in bilateral knee joint replacement surgery from 2019-2021

Abstract

Background: One of the proposed methods to reduce the risk of infection after joint replacement surgery is the use of disinfectant solutions at the end of the surgery. Different results have been reported regarding the effect of diluted betadine washing solutions and normal saline in reducing the risk of infection around the prosthesis.

Purpose: The purpose of this retrospective cohort study is to compare the use of diluted betadine wash solutions and normal saline in bilateral knee replacement surgery.

Materials and methods: In this retrospective cohort study, 320 patients who were referred to Baath Hospital from the beginning of 2019 to the end of 2021 for bilateral knee joint replacement were examined. 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 infection of the prosthesis area in these patients were examined three months after surgery.

Results: The average age of the patients was 64.5±6.1 years and their BMI was 27.7±2.0 kg/m2. Out of 320 patients, 177 (55.3%) were women, and the most underlying disease was type 2 diabetes with a frequency of 64 (20.0%). Out of 640 cases of operated knees, 17 cases (2.7%) of prosthetic area infection occurred after surgery, of which 11 cases (4.3%) were washed with normal saline (P=0.326). Multivariate regression analysis test showed male patients (P=0.028, OR=3.38). Patients with diabetes, (P=0.030, OR=3.03) blood pressure, (P=0.019, OR=3.81), and with the increase of each BMI unit (P=0.030, OR=1.36), the chance of infection in patients showed a significant increase.

Conclusion: The use of diluted betadine solution in bilateral knee replacement surgery for washing at the end of the surgery, especially in patients with underlying disease and obesity, can reduce the risk of infection.

1. Kurtz SM, Lau EC, Son MS, Chang ET, Zimmerli W, Parvizi J. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. J Arthroplasty. 2018;33(10):323-458.
2. Parvizi J, Gehrke T. Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331.
3. Bhatia D, Bejarano T, Novo M. Current interventions in the management of knee osteoarthritis. J Pharm Bioallied Sci. 2013;5(1):30-8.
4. Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One. 2016;11(3):e0150866.
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.
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.
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.
8. 14. 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 Joint Arthroplasty? J Arthroplasty, 2020; 5(35), 1374-1378.
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.e1.
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.
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.
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.
13. Rezapoor M, Parvizi J. Prevention of Periprosthetic Joint Infection. J Arthroplasty. 2015;30(6):902-7.
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.
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.
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.
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.
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.e1.
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.
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.
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.
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.
23. Jämsen 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.
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.
Files
IssueVol 10 No 1 (2024) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v10i1.14965
Keywords
total knee joint replacement diluted betadine infection around the prosthesis area.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shahbazi P, Ghorbani Amjad G. Comparison of the use of two washing solutions (diluted betadine and normal saline serum) in bilateral knee joint replacement surgery from 2019-2021. J Orthop Spine Trauma. 2024;10(1):19-24.