Use of a Novel Surgical Irrigant Significantly Reduces Rate of Infection in Primary Hip and Knee Arthroplasty at 1 year

Background: Periprosthetic joint infection (PJI) prevention in primary hip and knee arthroplasty remains an important challenge in arthroplasty. Dilute topical povidone–iodine followed by a sterile saline rinse is widely used for intraoperative irrigation and infection prophylaxis in surgery. The Food and Drug Administration recently issued a reminder about the nonsterility of topical iodine preparations used in deep surgical wounds. Thus, our institution sought a terminally sterilized alternative. We investigated a terminally sterile irrigant with minimal cytotoxicity, efficacy against biofilm, and no required secondary rinse. Methods: This was a single-surgeon retrospective cohort study of 2087 consecutive primary total hip and knee arthroplasties with minimum 1-year follow-up in a major metropolitan community hospital. The control group of 1045 patients received a dilute povidone-iodine soak followed by saline rinse. The experimental group of 1042 patients received the new irrigant (XPerience (XP)) without secondary rinse. The International Consensus Meeting 2018 recommended algorithm and criteria were used to diagnose PJI. Results: Overall, the PJI rate was 0% (0 of 1042) in the XP group and 0.6% (6/1045) in the povidone-iodine group (P = .017). The overall return to operating room rate was 0.5% (5 of 1042) in the XP group and 1.1% (12 of 1045) in the control group (P = .11). Conclusions: The novel solution had a lower infection rate in our cohort. We conclude that it is a comparable alternative to povidone–iodine. An ongoing prospective randomized control trial and a cost-benefit analysis may provide stronger guidance for surgeons.