JOA - 2026-04-24 - Journal Article
The One-Year Infection Rates After Vancomycin Powder and Dilute Povidone-Iodine Lavage in High-Risk Primary Total Joint Arthroplasty: A Multicenter Randomized Controlled Trial.
Saba BV, VPIP Study Group, Long WJ, Higuera CA, Dundon J, Cooper HJ, Dennis DA, Chen AF, Schwarzkopf R
Topics
Key Takeaway
In 1,830 high-risk primary TJA patients followed to one year, vancomycin powder, dilute povidone-iodine lavage, or their combination produced no statistically significant reduction in PJI requiring septic revision compared to saline control (THA p=0.62, TKA p=0.05).
Summary Depth
Choose how much analysis to show on this article page.
Summary
This multicenter RCT randomized 2,053 high-risk primary THA and TKA patients to intraoperative vancomycin powder, dilute povidone-iodine lavage, combination (VPIP), or saline control to assess 1-year PJI rates requiring septic revision. In THA, PJI rates ranged from 0.5% (vancomycin) to 1.9% (VPIP) with no significant difference (p=0.62); in TKA, rates ranged from 0% (iodine) to 2.0% (VPIP) with a borderline non-significant result (p=0.05). No significant between-group differences were detected at any time interval (0–3 months, 3–12 months, or combined 0–12 months) for either procedure.
Key Limitation
Per-protocol analysis with meaningful attrition (223 patients, ~11%) risks underpowering the study to detect a true treatment effect, particularly in the TKA cohort where the p=0.05 borderline result warrants cautious interpretation.
Original Abstract
INTRODUCTION
Given the severe morbidity, mortality, and substantial cost of periprosthetic joint infection (PJI), substantial research has been conducted to compare peri- and postoperative infection-prevention strategies. To our knowledge, there are no studies to date that have evaluated the one-year efficacy of intraoperative vancomycin powder and/or dilute povidone-iodine (DPI) lavage versus saline lavage in total joint arthroplasty. We previously reported no significant group differences at three months in a large multicenter randomized controlled trial. The present study reports 1-year outcomes of the same cohort.
METHODS
In this prospective, multicenter trial, 2,053 high-risk patients undergoing primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to one of four intraoperative protocols: vancomycin powder, DPI, VPIP (combination), or saline lavage control. The primary outcome was 1-year PJI resulting in septic revision surgery. Analyses were conducted on a per-protocol basis using Chi-square tests stratified by procedure. At one year, complete follow-up was available for 798 THA and 1,032 TKA patients after accounting for withdrawals, loss to follow-up, and nine unrelated deaths.
RESULTS
In the THA cohort, PJI occurred in 0.5% of vancomycin patients, 1.7% of iodine patients, 1.9% of VPIP patients, and 1.1% of saline patients (P = 0.62). In the TKA cohort, PJI occurred in 1.6% of vancomycin patients, none of the iodine patients, 2.0% of VPIP patients, and 0.4% of saline patients (P = 0.05). There were no significant differences between study groups at zero to three months (P = 0.14 for THA, P = 0.13 for TKA), three to 12 months (P = 0.67 for THA, P = 0.80 for TKA), or combined zero to 12 months (P = 0.62 for THA, P = 0.05 for TKA).
CONCLUSIONS
There were no significant differences in 1-year PJI rates observed across prophylactic strategies in high-risk primary THA or TKA. These findings suggest that intraoperative antiseptic and antibiotic protocols may have limited influence on longer-term outcomes.