Intraoperative wound irrigation prior to closure during total joint arthroplasty (TJA) is an essential component of preventing infections and limiting health care system costs. While studies have shown the efficacy of dilute betadine in reducing infection risk, there remains concerns over its safety profile and theoretical inactivation by blood and serum. This study aims to compare infection and wound complications between chlorhexidine gluconate (CHG) and betadine lavage during TJA. All primary TJA between 2019–2021 were analyzed at a single institution, and periprosthetic joint infection (PJI), wound drainage, 30 and 90-day emergency room (ER) readmission due to wound complications, aseptic loosening, and revision surgery rate were compared between patients undergoing intraoperative CHG versus betadine lavage prior to closure. Baseline demographics were controlled, and multivariate logistic regression was performed to compare complication rates. A total of 410 TJA, including 160 hip and 250 knee arthroplasties were included. Compared to the dilute betadine cohort, all TJA patients undergoing CHG lavage had a statistically significant lower 30 and 90-day emergency room readmission rate due to wound complications. Both hip and knee arthroplasty patients with CHG had a statistically significant lower rate of postoperative superficial drainage and dressing saturation at clinic follow-up, but only knee arthroplasty patients had significant decreased readmission rate for incisional wound vacuum placement and close inpatient monitoring of wound healing. Among all TJA, there was no significant association in the rate of PJI requiring return to the OR between groups. Although betadine is cost-effective and has been shown to reduce PJI rates, there remains concerns in the literature over soft tissue toxicity and wound healing. This study suggests CHG may be as efficacious as dilute betadine in preventing PJI while also decreasing the risk of superficial drainage and wound complications needing unplanned ER visits during the acute postoperative period.

中文翻译：

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与稀释的甜菜碱相比，全关节置换术期间的葡萄糖酸氯己定灌洗可改善伤口愈合

全关节置换术 (TJA) 期间闭合前的术中伤口冲洗是预防感染和限制医疗保健系统成本的重要组成部分。虽然研究表明稀释的甜菜碱可降低感染风险，但对其安全性以及理论上的血液和血清失活仍存在担忧。本研究旨在比较 TJA 期间葡萄糖酸氯己定 (CHG) 和 betadine 灌洗之间的感染和伤口并发症。在单一机构对 2019-2021 年所有原发性 TJA 进行分析，比较假体周围感染 (PJI)、伤口引流、30 天和 90 天急诊室 (ER) 因伤口并发症再入院、无菌性松动和翻修手术率术中 CHG 与关闭前灌洗的患者之间的差异。控制基线人口统计学，并进行多变量逻辑回归以比较并发症发生率。共纳入 410 例 TJA，包括 160 例髋关节和 250 例膝关节置换术。与稀释 betadine 队列相比，所有接受 CHG 灌洗的 TJA 患者由于伤口并发症而在 30 天和 90 天急诊室再入院率显着降低。在临床随访中，患有 CHG 的髋关节和膝关节置换术患者的术后浅表引流率和敷料饱和率均显着降低，但只有膝关节置换术患者的切口负压放置和住院密切监测伤口愈合的再入院率显着降低。在所有 TJA 中，组间需要返回 OR 的 PJI 率没有显着相关性。尽管 betadine 具有成本效益并且已被证明可以降低 PJI 率，但文献中仍然存在对软组织毒性和伤口愈合的担忧。这项研究表明 CHG 在预防 PJI 方面可能与稀释的 betadine 一样有效，同时还降低了在术后急性期需要计划外急诊就诊的浅表引流和伤口并发症的风险。