Normal Saline Irrigation versus Betadine Irrigation in Primary Joint Replacement: A Comparative Observational Study

Background: Intraoperative antiseptic irrigation has been proposed to reduce periprosthetic joint infections (PJIs). Betadine (povidone-iodine) is widely used, but its superiority over normal saline irrigation remains debated. Methods: This retrospective observational study analyzed 102 patients undergoing primary total cemented arthroplasty replacement between January 1, 2023, and May 31, 2025. Group A ( n = 52) underwent irrigation with normal saline only, whereas Group B ( n = 50) received additional full-strength Betadine irrigation before implant placement. Patients were matched for age, gender, comorbidities (diabetes and hypertension), and duration of surgery. All patients received antibiotic-loaded cement and identical postoperative antibiotic prophylaxis. Results: At 90-day follow-up, no deep-seated PJI was detected in either group. One superficial surgical site infection occurred in the Betadine group, attributed to a stitch abscess/possible Vicryl reaction, which resolved with conservative management. Statistical analysis confirmed no significant difference in infection rates between the groups. Conclusion: Betadine irrigation did not confer additional protection against infection compared to normal saline irrigation when antibiotic cement was used. Normal saline was noninferior to Betadine irrigation in preventing early postoperative infections in primary total knee replacement. Larger, prospective randomized controlled trials are warranted.