Octenidine-Based Versus Chlorhexidine-Based Preoperative Skin Antisepsis in Primary Hip and Knee Arthroplasty

Surgical site infection (SSI) and periprosthetic joint infection (PJI) remain major complications after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Preoperative antisepsis bundles are essential components of infection-prevention pathways; however, comparative data on octenidine-based vs chlorhexidine-based protocols remain limited. This study compared infectious and wound-related outcomes between these bundles in primary THA and TKA.

This retrospective cohort study included 1767 consecutive patients who underwent primary THA or TKA between March 2015 and September 2024. Patients were stratified by antisepsis bundle: chlorhexidine-based group, 867 patients; and octenidine-based group, 900 patients. Baseline characteristics, American Society of Anesthesiologists class, comorbidities, procedure type, wound complications, SSI, PJI, readmission, and revision surgery were analyzed. Primary outcomes were 30-day superficial SSI, 90-day deep SSI/PJI, and 1-year PJI. Secondary outcomes included composite infectious and wound-related events. Between-group comparisons and adjusted analyses were performed where permitted.

Baseline characteristics were comparable. Thirty-day superficial SSI occurred in 0.8% of chlorhexidine patients and 1.1% of octenidine patients (Relative risk [RR], 1.38; 95% confidence interval (CI), 0.53-3.61; P = .682). Ninety-day deep SSI/PJI occurred in 0.1% vs 0.0% (RR, 0.32; 95% CI, 0.01-7.80; P = .491), and 1-year PJI in 0.1% vs 0.0% (RR, 0.32; 95% CI, 0.01-7.80; P = .491). Composite infectious events were similar (0.9% vs 1.1%; RR, 1.20; 95% CI, 0.47-3.04; P = .875). Composite wound-related events occurred in 45.1% vs 41.7% (RR, 0.92; 95% CI, 0.83-1.03; P = .159).

Octenidine-based preoperative antisepsis showed outcomes comparable to chlorhexidine-based antisepsis in primary THA and TKA.