Lung Brandon E, Le Ryan, Callan Kylie, McLellan Maddison, Issagholian Leo, Yi Justin, McMaster William C, Yang Steven, So David H
Department of Orthopaedic Surgery, University of California Irvine Medical Center, 101 The City Drive South, Pavilion 3, Orange, CA, 92868, USA.
School of Medicine, University of California Irvine, Irvine, CA, 92617, USA.
J Exp Orthop. 2022 Jul 10;9(1):67. doi: 10.1186/s40634-022-00503-w.
Intraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA.
All primary TJA between 2019-2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates.
A total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups.
Although betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.
全关节置换术（TJA）闭合伤口前进行术中伤口冲洗是预防感染和控制医疗系统成本的重要环节。虽然研究表明稀释的碘伏在降低感染风险方面有效，但人们仍对其安全性以及血液和血清对其理论上的灭活作用存在担忧。本研究旨在比较TJA期间葡萄糖酸洗必泰（CHG）和碘伏灌洗的感染及伤口并发症情况。
对一家机构2019年至2021年期间所有初次TJA进行分析，比较闭合伤口前接受术中CHG灌洗与碘伏灌洗的患者之间的假体周围关节感染（PJI）、伤口引流情况、因伤口并发症导致的30天和90天急诊室（ER）再入院率、无菌性松动以及翻修手术率。对基线人口统计学特征进行控制，并进行多因素逻辑回归以比较并发症发生率。
共纳入410例TJA，包括160例髋关节置换和250例膝关节置换。与稀释碘伏组相比，所有接受CHG灌洗的TJA患者因伤口并发症导致的30天和90天急诊室再入院率在统计学上显著更低。CHG组的髋关节和膝关节置换患者在门诊随访时术后浅表引流和敷料浸湿率在统计学上均显著更低，但只有膝关节置换患者因切口伤口负压引流和密切住院观察伤口愈合的再入院率显著降低。在所有TJA中，两组之间需要返回手术室的PJI发生率无显著关联。
虽然碘伏具有成本效益且已被证明可降低PJI发生率，但文献中仍对其软组织毒性和伤口愈合存在担忧。本研究表明，CHG在预防PJI方面可能与稀释碘伏同样有效，同时还可降低术后急性期浅表引流和需要非计划急诊就诊的伤口并发症风险。
