¹Critelli M, ²Rasmussen J, ¹Shindler S, ³Reasch C, ⁴Patel A, ⁴Patel M, ⁵Law J
¹Texas College of Osteopathic Medicine, Arlington, Texas, United states; ²Valley Consortium for Medical Education, Modesto, CA, United states; ³Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, United states; ⁴College of Osteopathic Medicine, Kansas City University, Kansas City, MO, United states; ⁵Valley Orthopaedic Bone & Joint, Modesto, CA, United states

Introduction: Periprosthetic joint infections (PJIs) are among the most severe complications following total joint arthroplasty (TJA), contributing to increased patient morbidity, extended hospital stays, revision surgeries, and a substantial economic burden on the healthcare system [1]. As antimicrobial resistance grows, the need for innovative strategies to prevent PJIs becomes increasingly critical. Antimicrobial-impregnated dressings (AMIDs), particularly silver- and iodine-based variants, have emerged as promising prophylactic tools to reduce postoperative infection rates.

Methods: This literature review was conducted by five independent reviewers using PubMed, Google Scholar, and ScienceDirect to evaluate the clinical effectiveness of silver- and iodine-based AMIDs in reducing the incidence of PJIs in total hip and knee arthroplasty. Studies were selected based on relevance, use of AMIDs in primary TJA, and inclusion of postoperative infection outcomes.

Results: PJIs occur in up to 2% of patients undergoing TJA, with revision surgeries for infection accounting for significant healthcare costs [2]. The pathophysiology of PJIs involves early microbial adhesion, biofilm formation, and evasion of host immunity, making early prevention essential. Silver-based AMIDs demonstrated consistent efficacy in reducing superficial and deep surgical site infections, with several studies reporting statistically significant decreases in PJI rates when used perioperatively [2]. Iodine-based dressings, though less extensively studied in orthopedic surgery, also showed bactericidal activity and effectiveness in reducing infection rates [3]. Additionally, silver dressings provided benefits such as improved wound healing, reduced pain, and longer wear times. Cost-effectiveness analyses further support the use of AMIDs, suggesting they are a financially viable intervention given their low number needed to treat (NNT) to prevent one PJI [1].
Conclusion: AMIDs, especially silver-based dressings, offer a safe, effective, and cost-efficient method to reduce postoperative infections in total joint arthroplasty. Their broad-spectrum antimicrobial properties and low toxicity profile make them a valuable adjunct in surgical site management. Further high-powered, randomized controlled trials are needed to standardize protocols and optimize clinical outcomes across different patient populations and joint procedures.

References

1. Toppo AJ, et al., Journal of Arthroplasty. 2021
2. Grosso MJ, et al., The Journal of Arthroplasty. 2017
3. Casey AL, et al., Journal of Antimicrobial Chemotherapy. 2015
4. Kuo FC, et al., The Journal of Arthroplasty. 2020