Seta Joseph F, Weaver Martin J, Hallstrom Brian R, Zheng Huiyong T, Larese Devon M, Dailey Elizabeth A, Markel David C
Department of Orthopaedic Surgery, Henry Ford Providence, Southfield, Michigan.
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan.
J Arthroplasty. 2025 Aug;40(8S1):S297-S303.e2. doi: 10.1016/j.arth.2025.03.062. Epub 2025 Apr 5.
Periprosthetic joint infections remain a major complication in total joint arthroplasty. Tremendous efforts made intraoperatively to prevent periprosthetic joint infection during primary procedures include antiseptics or antibiotics in irrigation solutions. This study analyzed the incidence of postoperative infection in relation to use of irrigation solutions and antibiotic powder.
We reviewed primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases from the Michigan Arthroplasty Registry Collaborative Quality Initiative between January 2019 and December 2022. Data on irrigation solutions were categorized by those containing antibiotics, chlorhexidine-gluconate, povidone-iodine, or other substances, compared to normal saline. Logistic regression analyses were conducted, adjusting for various factors such as age, body mass index, sex, American Society of Anesthesiologists score, smoking, and more. There were 67,871 THA and 105,963 TKA cases analyzed, with an overall infection rate of 0.6% (confidence interval: 0.6 to 0.7, n = 420) for THA and 0.4% (0.36 to 0.43, n = 419) for TKA within 90 days postsurgery.
There were statistical differences between the use of normal saline alone versus other irrigation solutions in THA, including povidone and others. For TKA, there was a statistically significant difference with lower infection rates using normal saline alone than multiple types, chlorhexidine-gluconate, and povidone. Notably, the use of nonsaline irrigation increased over the study period.
There was no reduction in 90-day infection rates for primary THA or TKA with irrigation additives. Higher infection rates were noted with povidone than saline for THA and TKA, potentially due to selection bias or local adverse tissue effects. Topical powders did not improve infection control. While irrigation is strongly recommended in all patients having TKA or THA, multiple irrigation solutions were not correlated with lower infection rates, suggesting importance of patient selection and optimization over irrigation type.
人工关节周围感染仍然是全关节置换术中的主要并发症。在初次手术中，为预防人工关节周围感染所做的巨大努力包括在冲洗液中使用防腐剂或抗生素。本研究分析了与冲洗液和抗生素粉末使用相关的术后感染发生率。
我们回顾了2019年1月至2022年12月期间密歇根关节置换登记协作质量倡议中的初次全髋关节置换术（THA）和全膝关节置换术（TKA）病例。与生理盐水相比，冲洗液的数据按含有抗生素、葡萄糖酸氯己定、聚维酮碘或其他物质进行分类。进行了逻辑回归分析，并对年龄、体重指数、性别、美国麻醉医师协会评分、吸烟等各种因素进行了调整。共分析了67,871例THA和105,963例TKA病例，THA术后90天内的总体感染率为0.6%（置信区间：0.6至0.7，n = 420），TKA为0.4%（0.36至0.43，n = 419）。
在THA中，单独使用生理盐水与使用其他冲洗液（包括聚维酮等）之间存在统计学差异。对于TKA，单独使用生理盐水的感染率低于多种类型、葡萄糖酸氯己定和聚维酮，差异具有统计学意义。值得注意的是，在研究期间非生理盐水冲洗的使用有所增加。
使用冲洗添加剂对初次THA或TKA的90天感染率没有降低作用。对于THA和TKA，聚维酮的感染率高于生理盐水，这可能是由于选择偏倚或局部组织不良影响。局部粉末并未改善感染控制。虽然强烈建议所有接受TKA或THA的患者进行冲洗，但多种冲洗液与较低的感染率无关，这表明患者选择和优化比冲洗类型更重要。
