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Israel et al: Preclosure povidone‐iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis
Veterinary Surgery 1, 2023

🔍 Key Findings

  • No infections (0/102) occurred in cases where preclosure povidone-iodine lavage (PrePIL) was used, compared to 21/2111 (0.99%) with saline lavage.
  • Break-even cost for PrePIL was calculated at $49.74, while the actual cost was only $2.07, confirming strong cost-effectiveness.
  • No adverse reactions or healing complications were reported in the 102 PrePIL cases.
  • The PrePIL protocol used 0.35% povidone-iodine for 3 minutes before closure, followed by sterile saline lavage.
  • Majority of THRs (97%) used cementless fixation (BFX) in PrePIL group; only 3 cases used CFX components.
  • Surgeries followed consistent perioperative antibiotic protocols, making PrePIL the only major protocol variable.
  • Antibiotics were not added to lavage, aligning with WHO and CDC guidelines for antimicrobial stewardship.
  • The infection reduction with PrePIL supports routine use in total hip replacement to reduce periprosthetic joint infections.

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← Articles

Israel et al: Preclosure povidone‐iodine lavage in total hip replacement surgery: Infection outcomes and cost–benefit analysis
Veterinary Surgery 1, 2023

🔍 Key Findings

  • No infections (0/102) occurred in cases where preclosure povidone-iodine lavage (PrePIL) was used, compared to 21/2111 (0.99%) with saline lavage.
  • Break-even cost for PrePIL was calculated at $49.74, while the actual cost was only $2.07, confirming strong cost-effectiveness.
  • No adverse reactions or healing complications were reported in the 102 PrePIL cases.
  • The PrePIL protocol used 0.35% povidone-iodine for 3 minutes before closure, followed by sterile saline lavage.
  • Majority of THRs (97%) used cementless fixation (BFX) in PrePIL group; only 3 cases used CFX components.
  • Surgeries followed consistent perioperative antibiotic protocols, making PrePIL the only major protocol variable.
  • Antibiotics were not added to lavage, aligning with WHO and CDC guidelines for antimicrobial stewardship.
  • The infection reduction with PrePIL supports routine use in total hip replacement to reduce periprosthetic joint infections.

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Multiple Choice Questions on this study

In Israel 2023 et al., on povidone-iodine lavage, which component best describes the composition and method of PrePIL?

A. 10% PI solution used undiluted
B. 0.35% PI solution applied for 3 minutes
C. PI with antibiotics for 5 minutes
D. 0.5% PI solution applied for 1 minute
E. PI with alcohol base used preoperatively

Answer: 0.35% PI solution applied for 3 minutes

Explanation: PrePIL involved a 0.35% povidone-iodine solution applied for 3 minutes using a low-pressure lavage.
In Israel 2023 et al., on povidone-iodine lavage, which of the following was *not* a complication noted in PrePIL cases?

A. Delayed wound healing
B. Febrile response
C. Implant loosening
D. Lameness
E. All of the above

Answer: All of the above

Explanation: None of these complications were reported in the PrePIL group, indicating good clinical safety.
In Israel 2023 et al., on povidone-iodine lavage, why was antibiotic addition to the lavage not used or recommended?

A. It increases the lavage cost
B. It may promote antibiotic resistance
C. It lacks support from WHO and CDC guidelines
D. It was shown to increase infection rates
E. It interferes with implant bonding

Answer: It lacks support from WHO and CDC guidelines

Explanation: The study aligned with global guidelines discouraging antibiotic addition to lavage solutions.
In Israel 2023 et al., on povidone-iodine lavage, what was the infection rate observed in the PrePIL group?

A. 0.5%
B. 0.99%
C. 1.5%
D. 0%
E. 2.0%

Answer: 0%

Explanation: No infections occurred in the 102 PrePIL cases, demonstrating 0% infection rate.
In Israel 2023 et al., on povidone-iodine lavage, what was the calculated break-even cost for the PrePIL protocol?

A. $10.00
B. $25.50
C. $49.74
D. $75.00
E. $100.00

Answer: $49.74

Explanation: The break-even cost for PrePIL use was calculated at $49.74, significantly higher than the actual $2.07 cost.

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