The Otto Aufranc Award: Iodine-Containing Products Are Safe in Allergy-Labeled Patients Undergoing Total Joint Arthroplasty: A Prospective Observational Study.

Abstract

Povidone-iodine (PVP-I) and iodophor-impregnated drapes are essential antiseptic measures for total joint arthroplasty (TJA). However, many surgical settings may prevent surgeons from using iodine-containing products when a patient has a documented allergy, even if the cross-reactivity is unproven or based on distant self-reported history. As iodine has been a well-accepted measure to reduce periprosthetic joint infections and surgical site infection, this study sought to prospectively evaluate the safety of using iodine-containing products (iodophors) in iodine allergy labeled patients undergoing TJA. In this prospective observational study, patients with documented iodine allergy undergoing primary TJA from July 2024 to October 2025 were enrolled. Patients completed a preoperative questionnaire including the source, duration, and type of allergic reaction. The standard-of-care operative workflow, including PVP-I nasal decolonization, use of iodophor-impregnated adhesive drape, and intraoperative lavage with diluted PVP-I was followed without deviation from protocol. The primary end point was any perioperative allergic reaction throughout the stay. Of the 1,211 primary TJA performed during this time, there were 37 (3.1%) iodine allergy labeled patients. There were five (13.5%) patients who had skin test-confirmed allergies, 25 (67.6%) patients who were allergic to contrast media, four (10.8%) patients who were allergic to betadine, and five (13.5%) patients who had a concurrent shellfish allergy. The mean reported allergy duration was 27.9 years. Questionnaire results showed patients reporting reactions of nausea and vomiting (78.4%), mild itching (83.8%), rash (29.9%), severe itching (62.2%), wheezing (78.4%), difficulty breathing (59.5%), and swelling (89.2%). Most patients (70%) reported more than one reaction. However, the enrolled patients in this study had no allergic reactions to the iodophors used in the perioperative period. Iodophors are safe in iodine-allergic patients undergoing TJA. No allergic reactions were observed in this study. These findings challenge routine iodophor avoidance, supporting standardized antiseptic protocols to minimize periprosthetic joint infection.