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

Aneesh V Samineni; Natalia Cruz-Ossa; Gireesh B Reddy; Colin A McNamara; Victor H Hernandez; Michele R D'Apuzzo

doi:10.1016/j.arth.2026.04.051

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

J Arthroplasty. 2026 Apr 21:S0883-5403(26)00387-6. doi: 10.1016/j.arth.2026.04.051. Online ahead of print.

Authors

Aneesh V Samineni¹, Natalia Cruz-Ossa¹, Gireesh B Reddy², Colin A McNamara¹, Victor H Hernandez¹, Michele R D'Apuzzo¹

Affiliations

¹ Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Miami, Florida.
² Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, Miami, Florida.

PMID: 42025856
DOI: 10.1016/j.arth.2026.04.051

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: allergy; infection; iodine; total hip arthroplasty; total knee arthroplasty.