Infection Prophylaxis in Total Joint Replacement

NCT ID: NCT06126614

Last Updated: 2024-09-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE3

Total Enrollment

21006 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-07

Study Completion Date

2028-11-30

Brief Summary

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Osteoarthritis (OA) is the most common cause of disability in older adults worldwide affecting 7% of the global population, or more than 500 million people globally. Total joint replacements (TJR) can help bring relief to those with osteoarthritis when other treatment options are no longer helpful. Infection is the main reason hip and knee replacements "fail". Failure leads to repeat surgeries that are often more complicated and less likely to be successful than the first surgery. Reducing the risk of infection is extremely important, antiseptic washes and antibiotics may help us do that. After joint replacement surgery, orthopaedic surgeons wash and clean the surgical wound to lower the risk of infection. The goal of this clinical trial is to determine if the use of antiseptic solutions to wash the surgical site and placing an antibiotic directly into the wound will reduce the number of infections requiring reoperation. Patients having total joint replacements will be randomized (like flipping a coin) to receive 6 possible combinations of washes and / or antibiotics. Participants will be followed for one year after TJR to compare the rate of infection in each group.

Detailed Description

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Conditions

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Periprosthetic Joint Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Povidone-Iodine 0.35% Lavage Solution

The study lavage solution (povidone-iodine) is the final lavage and is to be poured in and left for 3 minutes then removed by suction.

The study lavage solution will be a total volume of 1 litre, made with sterile isotonic saline.

Group Type EXPERIMENTAL

Povidone-Iodine

Intervention Type OTHER

0.35% povidone-iodine solution for irrigation

Povidone-Iodine 0.35% Lavage Solution and Vancomycin

The study lavage solution (povidone-iodine) is the final lavage and is to be poured in and left for 3 minutes then removed by suction. Two grams of vancomycin is applied to the deep joint (to arthrotomy in knee and deep to fascia in hip) following removal of the study lavage solution and immediately prior to closure.

The study lavage solution will be a total volume of 1 litre, made with sterile isotonic saline.

Group Type EXPERIMENTAL

Vancomycin Hydrochloride

Intervention Type DRUG

2 grams of topical vancomycin hydrochloride added to the wound

Povidone-Iodine

Intervention Type OTHER

0.35% povidone-iodine solution for irrigation

Chlorhexidine Gluconate 0.05% Lavage Solution

The study lavage solution (chlorhexidine-gluconate) is the final lavage and is to be poured in and left for 3 minutes then removed by suction.

The study lavage solution will be a total volume of 1 litre, made with sterile isotonic saline.

Group Type EXPERIMENTAL

Chlorhexidine Gluconate

Intervention Type DRUG

0.05% chlorhexidine gluconate solution for irrigation

Chlorhexidine Gluconate 0.05% Lavage Solution and Vancomycin

The study lavage solution (chlorhexidine gluconate) is the final lavage and is to be poured in and left for 3 minutes then removed by suction. Two grams of vancomycin is applied to the deep joint (to arthrotomy in knee and deep to fascia in hip) following removal of the study lavage solution and immediately prior to closure.

The study lavage solution will be a total volume of 1 litre, made with sterile isotonic saline.

Group Type EXPERIMENTAL

Chlorhexidine Gluconate

Intervention Type DRUG

0.05% chlorhexidine gluconate solution for irrigation

Vancomycin Hydrochloride

Intervention Type DRUG

2 grams of topical vancomycin hydrochloride added to the wound

Saline Lavage Solution

The study lavage solution (saline) is the final lavage and is to be poured in and left for 3 minutes then removed by suction.

The study lavage solution will be a total volume of 1 litre.

Group Type ACTIVE_COMPARATOR

Saline

Intervention Type OTHER

saline for irrigation

Saline Lavage Solution and Vancomycin

The study lavage solution (saline) is the final lavage and is to be poured in and left for 3 minutes then removed by suction.

Two grams of vancomycin is applied to the deep joint (to arthrotomy in knee and deep to fascia in hip) following removal of the study lavage solution and immediately prior to closure.

Group Type EXPERIMENTAL

Vancomycin Hydrochloride

Intervention Type DRUG

2 grams of topical vancomycin hydrochloride added to the wound

Saline

Intervention Type OTHER

saline for irrigation

Interventions

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Chlorhexidine Gluconate

0.05% chlorhexidine gluconate solution for irrigation

Intervention Type DRUG

Vancomycin Hydrochloride

2 grams of topical vancomycin hydrochloride added to the wound

Intervention Type DRUG

Povidone-Iodine

0.35% povidone-iodine solution for irrigation

Intervention Type OTHER

Saline

saline for irrigation

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Patients 18 years of age or older.
2. Undergoing primary or aseptic revision TJR.
3. No contraindications to study interventions.
4. Informed consent (participant or substitute decision maker) obtained and willing to comply with the protocol.

Exclusion Criteria

1. Received antibiotics for any reason in the two weeks prior to their TJR.
2. Chronic or acute infection at or near the TJR site.
3. Prior history of periprosthetic joint infection including any reoperation due to infection.
4. Undergoing surgery for a diagnosis of a fracture.
5. Open infected wounds on affected limb.
6. Undergoing bilateral TJR.
7. Currently enrolled in a study that does not permit co-enrollment.
8. Prior enrollment in the trial including the pilot study
9. Any condition or circumstance, which in the opinion of the Investigator, interferes with assessments or completion of the trial.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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McMaster University

OTHER

Sponsor Role collaborator

Ontario Clinical Oncology Group (OCOG)

OTHER

Sponsor Role collaborator

Hamilton Health Sciences Corporation

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Thomas J Wood, MD, FRCSC

Role: PRINCIPAL_INVESTIGATOR

Hamilton Health Sciences / McMaster University

Locations

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Hamilton Health Sciences - Juravinski Hospital and Cancer Centre

Hamilton, Ontario, Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Lindsay Maharaj, MSc

Role: CONTACT

905-521-2100 ext. 43814

Other Identifiers

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PiT-2023

Identifier Type: -

Identifier Source: org_study_id

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