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 in preventing periprosthetic joint infection (PJI).

Methods: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, Embase, and the Cochrane Library databases for studies comparing the use of different intraoperative irrigation following primary total hip arthroplasty and total knee arthroplasty 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% confidence interval (CI): 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 (risk ratio (RR) 0.60, 95% CI: 0.37 to 0.95; P = 0.029; I2 = 61%). However, no significant difference was observed in the subgroups for total hip arthroplasty (RR 0.92, 95% CI: 0.52 to 1.61; P = 0.57; I2 = 0%) and total knee arthroplasty (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 total joint arthroplasty. There was no significant difference between chlorhexidine and povidone-iodine.