Rinsing Effective at Reducing Infections After Joint Replacement Surgery

A new study finds that a three minute diluted betadine lavage, combined with painting of the skin with a 10% betadine solution prior to surgical closure, nearly eliminates early deep-postoperative infection.

Researchers at Rush University Medical Center (RUMC; Chicago, IL, USA) implemented a protocol for primary total knee and total hip arthroplasty in which the wound is soaked with the diluted betadine solution for three minutes following implantation of the prosthetic components. This is followed by a pulsating lavage of normal saline without antibiotics. Prior to final closure, betadine is applied to the skin surrounding the incision.

Acute periprosthetic joint infection--a rare but devastating complication associated with total joint replacement--was diagnosed in 18 out of the 1,862 cases performed prior to the initiation of the betadine protocol, when only saline was used for final lavage. In comparison, only one of the 688 total joint arthroplasties following initiation of this protocol was infected, representing a reduction of the infection rate from 0.97% to 0.15%. No side complications were associated with the treatment. The study was presented at the American Association of Orthopedic Surgeons annual meeting, held during February 2011 in San Diego (CA, USA).

"Betadine is safe, inexpensive, simple to use, and readily available within most operating rooms,” said lead author and study presenter Craig Della Valle, MD, an associate professor of orthopedic surgery at RUMC. "In addition, betadine is effective on many types of bacteria, including methicillin-resistant Staphylococcus Aureus.”

Betadine is a povidone-iodine (PVPI) topical antiseptic available in two formulations - a 10% povidone-iodine solution in water and a "surgical scrub,” which is a mixture of povidone-iodine and detergent, sold over-the-counter (OTC) as a skin cleaner and disinfectant hand wash, and used for cleansing hands prior to surgery and other aseptic procedures. Betadine is also used in hospital settings as part of a regimen for postexposure prophylaxis (PEP).

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