Efficacy Of Dilute Povidone-Iodine Versus 0.9% Normal Saline Irrigation In Primary Arthroplasty At Muhimbili Orthopedic Institute.

Abstract

Background Arthroplasty is a surgical procedure that just like any other surgery, is associated with complications such as surgical site infection and blood loss. In Muhimbili Orthopedic Institute, during primary arthroplasty, intraoperative irrigation is among the techniques carried out, with the aim of preventing the above complications. Depending on the surgeon’s preference, the wound is irrigated with either dilute povidone-iodine or 0.9% normal saline before closure. Objective This study was carried out to determine the efficacy of dilute povidone-iodine versus 0.9% normal saline irrigation in primary arthroplasty at Muhimbili Orthopedic Institute. Methodology It was a prospective cohort study that lasted six months. 88 participants who met inclusion criteria were enrolled. Data was collected using structured questionnaire. Important information collected were age, sex, surgery (TKR or THR), pre/post-operative hemoglobin, type of anaesthesia, positioning, limb operated, approach, duration of surgery, number of blood transfusions, Surgical Site Infection using suggestive criteria (pain, swelling,warmth, temperature, new onset of joint effusion, CRP, ESR and WBC) and Surgical Site Infection using confirmatory criteria ( fistula, sinus, wound breakage, pus discharge and culture). All participants were clinically examined post-operatively, at 2nd, 6th and 12th weeks. Data was analyzed using SPSS version 21. Results Out of 88 participants (44 each in dilute povidone-iodine group and 0.9% normal saline group), those irrigated by dilute povidone-iodine were 17(38.6%) male and 27(61.4)% female, while those with 0.9% normal saline were 20(45.5%) and 24(54.5%) respectively. Median age was 26. The commonest diagnosis was Osteoarthritis 71(80.7%) while the lowest was Avascular necrosis 6(6.8%). Five participants had surgical site infection based on positive culture results (One in dilute povidone-iodine group versus four in 0.9% normal vi saline group). This was not statistically significant with a p-value of 0.286. The mean difference in pre and post-operative hemoglobin in the dilute povidone-iodine group was - 8.52 ± 24.18 and in the 0.9% normal saline group was -9.45 ± 20.35. This was statistically significant with a p-value of 0.004. Conclusion There was no significant difference in surgical site infection rate between dilute povidone iodine and 0.9% normal saline irrigation in primary arthroplasty. However, there was less blood loss among participants who were irrigated with dilute povidone-iodine than with 0.9% normal saline in primary arthroplasty at Muhimbili Orthopedic Institute. Recommendation A study with a higher sample size and longer duration of time should be conducted to determine efficacy of irrigation fluids in primary arthroplasty involving various arthroplasty centers in Tanzania to increase generalisation of results.