The Prospective Randomized EValuation of Emerging Novel Treatments for Infection Prophylaxis in Total Joint Replacement (PREVENT-iT)

• Published in: JBJS Open Access
• Main Authors: Thomas J Wood, MD, MSc, FRCSC, Sameer Parpia, PhD, Isabelle Tate, MSc, Hassaan Abdel Khalik, MD, Ernesto Muñoz-Mahamud, MD, PhD, Michael Tanzer, MD, FRCSC, FAAOS, Adam Hart, MASc, MD, FRCSC, Anthony Albers, MDCM, FRCSC, Qirui Hou, MSc, Mohit Bhandari, MD PhD, the PREVENT-IT Investigators, Thomas J. Wood, Mohit Bhandari, Sheila Sprague, Sameer Parpia, Daniel Tushinski, Mitchell Winemaker, Kamal Bali, Dale Williams, Anthony Adili, Vickas Khanna, Anthony Albers, Adam Hart, Michael Tanzer, Juan Carlos Martínez Pastor, Ernesto Muñoz-Mahamud, Montse Monfort Mira, Clara Chimeno, Marc Ferrer Banús, Jenaro Ángel Fernández-Valencia Laborde, Mariano Balaguer Castro, Vall D'Hebron, Enric Castellet Feliu, Ernesto Guerra Farfan, Joan Minguell Monyart, Joan Pijoan Bueno, Marc Aguilar Garcia, Nayana Joshi Jubert, Merce Reverte Vinaixa, Marti Plomer Sanchez, Marcelo Casaccia, Alejandro Hernandez, Victor Barro, Andres Aliaga, Inaki Mimendia, Thomas J. Wood, MD, MSc, FRCSC, Michael Tanzer, MD FRCSC, FAAOS, Mohit Bhandari, MD, PhD, Yang Wang, Qirui Hou, Darren De Sa, MD, FRCSC, Carlos Prada, Mazan Badder, Laura Puri, Isabelle Tate, David Pogorzelski, Lindsay Maharaj, Kim Madden, Irene Portas Torres, Andrés Aliaga, Lori Burrows
• Format: Article
• Language: English
• Published: Wolters Kluwer 2025-09-01
• Online Access: http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.25.00150
• ISSN: 2472-7245

Background:. Despite the success of total joint arthroplasty for end-stage hip and knee osteoarthritis, periprosthetic joint infection (PJI) remains a devastating complication and leading cause of revision surgery. Antiseptic irrigation solutions and topical antibiotics are promising and cost-effective strategies for the prevention of PJIs, though high-quality evidence assessing their efficacy is lacking. Therefore, this study investigates the feasibility of conducting a definitive trial to determine the optimal prophylactic treatment of PJIs using various irrigation solutions and topical antibiotics. Methods:. Using a simple randomized 3 × 2 factorial trial, patients were randomized across 5 centers to 1 of 6 possible treatments (povidone-iodine, chlorhexidine-gluconate, or saline, with or without vancomycin). Nine criteria were assessed to evaluate feasibility including participant enrollment, administration of treatments, data collection methods, and protocol compliance. Adverse event rates were used to assess trial safety. Secondary outcomes included rates of PJI requiring reoperation and persistent wound drainage (PWD). Results:. Four hundred and ninety-five participants were included in the pilot trial. Study participants were 56% female with a mean age of 67 years. Seven of the 9 criteria assessing feasibility indicated the trial was successful and no modifications needed. Two criteria, treatment contamination (8.5%) and completeness of patient follow-up (93.8%), were graded as requiring minor adjustment before conducting the definitive trial. There were 114 serious adverse events; none of which were deemed associated with the treatments. Overall, 9 (1.84%) presented with PJIs requiring reoperation, and 6 patients (1.12%) presented with PWD. Conclusion:. This study demonstrates the feasibility and safety of prophylactic irrigation solutions and topical antibiotics. PREVENT-IT has received funding from the Canadian Institutes of Health Research toward the definitive, large, multicenter randomized controlled trial (NCT06126614).Ultimately, findings will directly affect clinical practice with the potential to positively influence global rates of PJI. Level of Evidence:. NA.