Chlorhexidine or Povidone-Iodine Solution Irrigation versus Saline Irrigation for the Prevention of Postoperative Infections in Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

Background: This study evaluated the effectiveness of antiseptic irrigation solutions, specifically chlorhexidine, and povidone-iodine, compared to normal saline after primary total joint arthroplasty (TJA) in preventing periprosthetic joint infection (PJI).

Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, and the Cochrane Library databases for studies comparing the use of different intraoperative irrigation following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). A total of 11 studies, including 67,742 patients, were included. The outcome of interest was the rate of deep infections. Statistical analysis was conducted using a random-effect model, with heterogeneity assessed via I2 statistics.

Results: The random-effect model analysis revealed a PJI rate of 1.02% (95% CI [confidence interval]: 0.77 to 1.35; I2 = 90%) for the total cohort. Among 24,025 patients who received irrigation with either povidone-iodine or chlorhexidine, the PJI rate was 0.86% (95% CI: 0.63 to 1.17; I2 = 75%). Povidone-iodine significantly reduced the risk of PJI compared to saline (RR [risk ratio] 0.60, 95% CI: 0.37 to 0.95; P = 0.029; I2 = 61%). However, no significant difference was observed in the subgroups for THA (RR 0.92, 95% CI: 0.52 to 1.61; P = 0.57; I2 = 0%) and TKA (RR 0.92, 95% CI: 0.47 to 1.77; P = 0.21; I2 = 35%). Chlorhexidine also reduced the risk compared to saline (RR 0.60, 95% CI: 0.45 to 0.82; P = 0.001; I2 = 0%). There was no significant difference between povidone-iodine and chlorhexidine (RR = 1.60, 95% CI: 0.84 to 3.06; P = 0.154; I2 = 0%).

Conclusions: In this meta-analysis, chlorhexidine and povidone-iodine had a significantly reduced risk of PJI as compared with saline irrigation in TJA. There was no significant difference between chlorhexidine and povidone-iodine.