Summary

Chlorhexidine or Povidone-Iodine Solution in Primary Total Joint Arthroplasty

Abstract

Background

This study evaluated the effectiveness of antiseptic irrigation solutions, specifically chlorhexidine and povidone-iodine, compared to normal saline in preventing periprosthetic joint infection (PJI) after primary total joint arthroplasty.

Methods

Adhering to PRISMA guidelines, we searched MEDLINE, Embase, and the Cochrane Library databases for studies comparing the use of different intraoperative irrigation following primary total hip and knee arthroplasty. The outcome of interest was the rate of deep infections, which was used to evaluate the proportion of patients infected and compare groups. Statistical analysis was conducted using a random-effect model, with heterogeneity assessed via I² statistics.

Results

A total of 11 studies including 67,742 patients were included. The random-effect model analysis revealed a PJI rate of 1.02% (95% CI: 0.77% to 1.35%; I²= 90%) for the total cohort. Among 24,025 patients who received irrigation with either povidone-iodine or chlorhexidine, the PJI rate was 0.86% (95% CI: 0.63% to 1.17%; I² = 75%). Povidone-iodine significantly reduced the risk of PJI compared to saline (RR 0.60, 95% CI: 0.37 to 0.95; P=029 ; I²= 61%). Chlorhexidine also reduced the risk compared to saline (RR 0.60, 95% CI: 0.45 to 0.82; P=.001; I²= 0%). There was no significant difference between povidone-iodine and chlorhexidine (RR = 1.60, 95% CI: 0.84 to 3.06; P=.154; I²= 0%).

Conclusion

In this meta-analysis chlorhexidine and povidone-iodine had a significantly reduced risk of PJI compared with saline irrigation in total joint arthroplasty. There was no significant difference between chlorhexidine and povidone-iodine.