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The Otto Aufranc Award: Iodine-Containing Products Are Safe in Allergy-Labeled Patients Undergoing Total Joint
Aneesh V Samineni1, Natalia Cruz-Ossa1, Gireesh Reddy2
1Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida.
Background:
Povidone-iodine (PVP-I) and iodophor-impregnated drapes are essential antiseptic measures for total joint arthroplasty (TJA). However, many surgical settings may prevent surgeons from using iodine-containing products when a patient has a documented allergy, even if the cross-reactivity is unproven or based on distant self-reported history. As iodine has been a well-accepted measure to reduce periprosthetic joint infections and surgical site infection, this study sought to prospectively evaluate the safety of using iodine-containing products (iodophors) in iodine allergy labeled patients undergoing TJA.
Methods:
In this prospective observational study, patients with documented iodine allergy undergoing primary TJA from July 2024 to October 2025 were enrolled. Patients completed a preoperative questionnaire including the source, duration, and type of allergic reaction. The standard-of-care operative workflow, including PVP-I nasal decolonization, use of iodophor-impregnated adhesive drape, and intraoperative lavage with diluted PVP-I was followed without deviation from protocol. The primary end point was any perioperative allergic reaction throughout the stay.
Results:
Of the 1,211 primary TJA performed during this time, there were 37 (3.1%) iodine allergy labeled patients. There were five (13.5%) patients who had skin test-confirmed allergies, 25 (67.6%) patients who were allergic to contrast media, four (10.8%) patients who were allergic to betadine, and five (13.5%) patients who had a concurrent shellfish allergy. The mean reported allergy duration was 27.9 years. Questionnaire results showed patients reporting reactions of nausea and vomiting (78.4%), mild itching (83.8%), rash (29.9%), severe itching (62.2%), wheezing (78.4%), difficulty breathing (59.5%), and swelling (89.2%). Most patients (70%) reported more than one reaction. However, the enrolled patients in this study had no allergic reactions to the iodophors used in the perioperative period.
Conclusions:
Iodophors are safe in iodine-allergic patients undergoing TJA. No allergic reactions were observed in this study. These findings challenge routine iodophor avoidance, supporting standardized antiseptic protocols to minimize periprosthetic joint infection.
