The Role of Antiseptic Irrigation Solutions and Topical Antibiotics in Total Joint Arthroplasty


Prosthetic joint infections (PJI) are devastating complications. Antiseptic irrigation fluids have shown promising in vitro results in eradicating planktonic bacteria and decreasing biofilm burden. Topical antibiotics, specifically vancomycin, represents another potentially cost-effective way to prevent acute postoperative PJI. We provide a review of the current literature and recommendations on these measures. Overall, a current lack of high-powered, prospective studies exists to definitively support the use of any specific antiseptic solution or topical antibiotic in primary or revision total joint arthroplasty. Some studies support the use of dilute povidone-iodine lavage when combined with vancomycin powder. Data also exists to support the cost effectiveness of povidone-iodine, with the necessary risk reduction to justify its cost. Contradictory evidence exists demonstrating no differences in PJI rates with these measures and possibly higher rates of aseptic wound complications associated with vancomycin power. Further study is warranted. (Journal of Surgical Orthopaedic Advances 30(4):226–230, 2021)

Key words: prosthetic joint infection, irrigation solutions, topical antibiotics, Betadine povidone-iodine, vancomycin, chlorhexidine gluconate

Joshua T. Anderson, MD; A. Jack Barnes, MD; and Jeffrey B. Stambough, MD