Intrawound Vancomycin and Povidone-Iodine Treatment to Reduce Infection Rates in Arthroplasty

Patients of all age groups undergoing arthroplasty surgeries can develop surgical site infection after operation, which represents a major source of patient harm. Intrawound vancomycin and irrigation with dilute povidone-iodine is a potential prophylactic measure to prevent infection; thus, this prospective clinical observational study was done to evaluate its efficacy.

Patients who underwent arthroplasty surgeries (total knee arthroplasty, total hip arthroplasty, hip bipolar hemiarthroplasty) at one specialist tertiary care center, from October 2020 to October 2022, were included in our study. Patients <18 years of age and known cases of vancomycin allergy were excluded from the study. These were the inclusion and exclusion criteria in our study. Participants were split into two groups: Group 1, vancomycin povidone-iodine protocol (VPIP) not initiated, and Group 2, VPIP initiated. The period of follow-up was 6 weeks, and the primary outcome under consideration was wound healing. After 6 weeks, patients in both groups were assessed using the ASEPSIS wound score, assigned to a category of infection, and the results compared between the groups.

Mean ASEPSIS scores in Groups 1 and 2 were 4.46 (±7.6) and 1.17 (±3.7), respectively, while overall infection rates were 5.8% and 0.8%. The chance of developing infection was 11-fold higher in Group 1 patients than those in Group 2, which was a highly significant difference (adjusted odds ratio = 11.651; 95% confidence interval, 1.27-106.76; P < 0.05). The likelihood of developing an infection was significantly higher among individuals with diabetes mellitus (P < 0.05).

Use of the VPIP in patients undergoing arthroplasty generated good results, indicating that it is a good infection prevention measure. Additional randomized controlled trials are needed to assess the effectiveness of this method and ascertain whether its extensive utilization is justified.