Muwanis Mashael, Barimani Bardia, Luo Lucy, Wang Casey K, Dimentberg Ronald, Albers Anthony
Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada.
Department of Orthopaedic Surgery, Taibah University, Madinah, Saudi Arabia.
Arch Orthop Trauma Surg. 2023 Apr;143(4):2175-2180. doi: 10.1007/s00402-022-04451-z. Epub 2022 Apr 30.
One of the most important challenges faced by orthopedic surgeons is periprosthetic joint infection (PJI). PJI is a common cause for total joint arthroplasty failure with an incidence of 0.3-1.9%. PJI can be devastating for the patient and extremely costly for the healthcare system. There is concern that a major cause of PJI is intra-operative colonization and recent studies have shown a decrease in PJI with the use of dilute povidone-iodine (Betadine, Avrio Health L.P, Stamford, CT) irrigation prior to wound closure. This study presents our experience with the use of dilute Betadine irrigation prior to wound closure and its effect on our post-operative hip and knee arthroplasty acute infection rate.
Retrospective chart review performed at our hospital looking at PJI amongst patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2013 and 2017 comparing different irrigation methods (n = 3232). The study group (n = 1207) underwent irrigation prior to wound closure with dilute Betadine for 3 min and the control group (n = 1511) underwent irrigation using normal saline (NS).
Using a logistic regression model where the following variables were adjusted for; ASA, age, sex, foley insertion, surgical duration and diabetes mellitus status a statistical significant reduction was seen in any infection (OR 0.45 [0.22; 0.89], p value < 0.05) and SSI (OR 0.30 [0.13; 0.70], p value 0.01) with the Betadine group. No significant reduction was seen with deep infections with the Betadine group compared to the NS group.
PJI is a devastating complication following total joint arthroplasty and we found Betadine compared to NS irrigation provides an inexpensive and simple method to lower any PJI and more specifically SSI in THA and TKA.
III.
骨科医生面临的最重要挑战之一是假体周围关节感染（PJI）。PJI是全关节置换失败的常见原因，发病率为0.3 - 1.9%。PJI对患者可能是灾难性的，对医疗系统而言成本极高。有人担心PJI的一个主要原因是术中定植，最近的研究表明，在伤口闭合前使用稀释聚维酮碘（碘伏，Avrio Health L.P，斯坦福德，康涅狄格州）冲洗可降低PJI的发生率。本研究介绍了我们在伤口闭合前使用稀释碘伏冲洗的经验及其对术后髋膝关节置换急性感染率的影响。
在我院进行回顾性病历审查，观察2013年至2017年间接受初次全髋关节置换术（THA）或全膝关节置换术（TKA）的患者中的PJI情况，比较不同的冲洗方法（n = 3232）。研究组（n = 1207）在伤口闭合前用稀释碘伏冲洗3分钟，对照组（n = 1511）用生理盐水（NS）冲洗。
使用逻辑回归模型对以下变量进行调整；美国麻醉医师协会（ASA）分级、年龄、性别、留置导尿管、手术时间和糖尿病状态，碘伏组在任何感染（比值比[OR]0.45[0.22；0.89]，p值<0.05）和手术部位感染（OR 0.30[0.13；0.70]，p值0.01）方面有统计学显著降低。与NS组相比，碘伏组深部感染未见显著降低。
PJI是全关节置换术后的灾难性并发症，我们发现与NS冲洗相比，碘伏冲洗提供了一种廉价且简单的方法来降低THA和TKA中的任何PJI，更具体地说是手术部位感染。
III级
