Risk-stratified association between dilute povidone-iodine lavage and SSI/PJI after primary total hip arthroplasty.

introductionUnresolved issue remains regarding which patient populations benefit from diluted povidone-iodine (PI) irrigation for preventing surgical-site infection (SSI)/periprosthetic joint infection (PJI) after primary total hip arthroplasty (THA). We aimed to clarify the clinical effect of diluted PI lavage on SSI/PJI incidence in risk-stratified patients undergoing primary THA.

methodsThis retrospective, single-center study included 1,128 patients with primary THA for osteoarthritis. We classified all enrolled patients into three groups according to the American Society of Anesthesiologists Physical Status (ASA-PS) 1, 2, and 3 groups. We compared the incidence rate of SSI/PJI between two subgroups in each group: patients who received diluted PI and those who did not. Odds ratios (ORs) for SSI/PJI were estimated for PI irrigation.

resultsEleven infections occurred overall (0.9%): five superficial SSIs (0.4%) and six early PJIs (0.5%). No infections occurred among patients in the ASA-PS 1 group. In the ASA-PS 2 group, eight SSI/PJI events were observed (0.8%), and in ASA-PS 3, three SSI/PJI events occurred (3.3%). In the ASA-PS 2 group, PI use was associated with a lower infection rate (P = 0.04), whereas no significant difference was detected in ASA-PS 3 (P = 0.55). OR revealed that diluted PI caused a significant reduction in SSI/PJI (OR, 0.23; P = 0.03) in the ASA-PS 2 group. DISCUSSION: In this cohort, dilute PI lavage was associated with fewer SSI/PJI events among patients with ASA-PS class 2 who underwent primary THA; however, a clear benefit was not demonstrated in patients with ASA-PS class 3. Additional intraoperative measures may be required for higher-risk patients, such as those with ASA-PS class 3.