The One-Year Infection Rates After Vancomycin Powder and Dilute Povidone-Iodine Lavage in High-Risk Primary Total Joint Arthroplasty: A Multicenter Randomized Controlled Trial.

BACKGROUND

Given the severe morbidity, mortality, and substantial cost of periprosthetic joint infection (PJI), substantial research has been conducted to compare perioperative and postoperative infection-prevention strategies. To our knowledge, there are no studies to date that have evaluated the 1-year efficacy of intraoperative vancomycin powder and/or dilute povidone-iodine lavage versus saline lavage in total joint arthroplasty. We previously reported no significant group differences at 3 months in a large multicenter randomized controlled trial. The present study reports 1-year outcomes of the same cohort.

METHODS

In this prospective, multicenter trial, 2,053 high-risk patients undergoing primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to one of four intraoperative protocols: vancomycin powder, dilute povidone-iodine, vancomycin povidone-iodine protocol (VPIP, combination), or saline lavage control. The primary outcome was 1-year PJI resulting in septic revision surgery. Analyses were conducted on a per-protocol basis using Chi-square tests stratified by procedure. At 1 year, complete follow-up was available for 798 THA and 1,032 TKA patients after accounting for withdrawals, loss to follow-up, and nine unrelated deaths.

RESULTS

In the THA cohort, PJI occurred in 0.5% of vancomycin patients, 1.7% of iodine patients, 1.9% of VPIP patients, and 1.1% of saline patients (P = 0.62). In the TKA cohort, PJI occurred in 1.6% of vancomycin patients, none of the iodine patients, 2.0% of VPIP patients, and 0.4% of saline patients (P = 0.05). There were no significant differences between study groups at 0 to 3 months (P = 0.14 for THA, P = 0.13 for TKA), 3 to 12 months (P = 0.67 for THA, P = 0.80 for TKA), or combined 0 to 12 months (P = 0.62 for THA, P = 0.05 for TKA).

CONCLUSIONS

There were no significant differences in 1-year PJI rates observed across prophylactic strategies in high-risk primary THA or TKA. These findings suggest that intraoperative antiseptic and antibiotic protocols may have limited influence on longer-term outcomes.