Iodine Antiseptics Safe for Patients With Documented Iodine Allergy Labels

Periprosthetic joint infection remains among the most catastrophic complications in orthopedic surgery, associated with a 5.5-fold increase in 10-year mortality and annual hospital costs projected to reach $1.85 billion by 2030 [1, 2]. Effective prevention relies heavily on standardized antiseptic protocols, such as nasal decolonization and intraoperative irrigation, which are designed to reduce the bioburden of common pathogens and disrupt microbial biofilms (complex communities of bacteria that adhere to prosthetic surfaces and resist systemic antibiotics) [3, 4]. While some meta-analyses suggest that chlorhexidine-alcohol is superior for general surgical site preparation, specific data in bone and joint surgery have indicated a potential advantage for iodophor-alcohol combinations [5]. Despite the clinical utility of these agents, surgeons frequently encounter patients with documented iodine allergy labels, often leading to the avoidance of povidone-iodine products due to concerns over anaphylaxis or severe cutaneous reactions [6]. A new prospective study now evaluates the safety of maintaining standard iodine-based protocols in patients with these documented sensitivities.