Inexpensive Rinsing Reduces Post-Operative Infection After Total Joint Replacement Surgery

A rinsing technique with betadine that costs just a little over one dollar per patient may significantly reduce the infection rate following total knee and hip joint replacement surgery according to a study by researchers at Rush University Medical Center.

The study, presented at the American Association of Orthopedic Surgeons 2011 Annual Meeting, found that a three-minute diluted betadine lavage combined with painting of the skin with a 10 percent betadine solution prior to surgical closure nearly eliminated early deep post-operative infection.

Deep periprosthetic joint infection is a rare but devastating complication associated with total joint replacement. Despite aseptic techniques, careful skin preparation and prophylactic antibiotics, deep infections still occur with a prevalence ranging from 0.3 percent to 1.9 percent.

Previous research has shown that a diluted betadine lavage of the surgical wound prior to closure reduces the rate of post-operative infection in orthopedic, urologic, cardiovascular and general surgery but it has not been previously studied in total joint arthroplasty.

"Betadine is safe, inexpensive, simple to use, and readily available within most operating rooms," says study author Dr. Craig Della Valle, associate professor of orthopedic surgery at Rush. "In addition, betadine is effective on many types of bacteria including methicillin-resistant Staphylococcus aureus (MRSA).

Researchers 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. Prior to this protocol, wounds were lavaged with normal saline only.

Acute post-operative deep infection was diagnosed in 18 out of the 1862 cases performed prior to the initiation of the betadine lavage protocol and in only one of the 688 total joint arthroplasties following initiation of this protocol; a reduction of the infection rate from 0.97 percent to 0.15 percent. There were no side complications associated with the treatment.

The study authors caution there are some limitations to the study. Changes in the surgeons technique occurred over the time of the study, and it was not feasible to determine the impact of these changes on the rate of infection. These included variations in the incision size, suture material, and type of skin sealant.