Effectiveness of Surgical Skin Preparation Solutions in Orthopaedic Surgery: A Systematic Review of the Current Comparative Literature

Division

North Texas

Hospital

Medical City Denton

Document Type

Manuscript

Publication Date

10-18-2025

Keywords

Chlorhexidine, Infection, Iodine, Orthopaedics, Surgical skin prep

Disciplines

Bacterial Infections and Mycoses | Medicine and Health Sciences | Orthopedics | Surgical Procedures, Operative

Abstract

BACKGROUND: Surgical site infection (SSI) is a major concern in orthopaedic surgery procedures as they can have devastating consequences for patients and their outcomes. Many infection prevention measures are routinely taken in order to prevent infection during surgery, the main one being surgical skin preparation prior to any incision.

AIM: To investigate the efficacy of different perioperative surgical skin preparation products commonly used in orthopaedic surgery.

METHODS: Seven databases were searched from inception to January 25, 2025, using a combination of keywords and medical subject headings terms, specifically for studies comparing any two surgical skin preparation products used at any point prior to skin incision for orthopaedic procedures. Titles and abstracts were screened and full texts reviewed based on inclusion criteria. Data was extracted on study design, interventions, and outcomes from studies that met inclusion criteria. Meta-analysis was not completed due to heterogeneity.

RESULTS: Thirty-two studies met the inclusion criteria in this systematic review. In extremity fracture surgery, evidence was mixed on whether iodine or chlorhexidine-based solutions are more effective at preventing SSI. No significant difference was found between iodine and chlorhexidine-based solutions in total joint arthroplasty, spine surgery, foot and ankle surgery, or upper extremity surgery. No tested preparation method was superior in reducing positive

CONCLUSION: Current literature shows no significant difference between chlorhexidine-based and iodine-based skin preparation solutions in orthopaedic extremity or spine surgery regarding SSI prevention or culture results. Likewise, adding other antiseptic agents provided no clear benefit. While skin antisepsis is important, many different factors contribute to SSI risk outside of the skin preparation solution.

Publisher or Conference

World Journal of Orthopedics

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