In the absence of reliable evidence for the use of an antiseptic wash during total hip or knee arthroplasty, it is the opinion of this work group that dilute betadine lavage be used as a method to decrease infection risk in hip or knee arthroplasty.

Rationale
One low strength study (Brown et al. 2012) evaluated the use of a dilute betadine lavage as a method to reduce the risk of periprosthetic joint infection within 90 days of hip or knee replacement. The study reports a significant decrease in the infection rate following implementation of the betadine lavage protocol. Patients with a documented allergy to iodine were excluded from the study.

POSSIBLE HARMS OF IMPLEMENTATION
There are no known harms associated with implementing this recommendation with the understanding thatpatients with allergy to iodine / betadine would be excluded from the intervention.

FUTURE RESEARCH
The cited study outlines a specific concentration and protocol for the application of the betadine wash. Further high-quality studies are needed to corroborate the results of this study and to further define the method of use.
  1. Brown,N.M., Cipriano,C.A., Moric,M., Sporer,S.M., Della Valle,C.J. Dilute betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection. J.Arthroplasty 2012/1; 1: 27-30