Is Dilution Really the Solution to Pollution? Irrigation in Total Joint Arthroplasty .

Irrigation during total joint arthroplasty (TJA) is meant to clear bacteria and debris, yet the best approach remains uncertain. Surgeons commonly rely on saline, with some choosing diluted povidone-iodine, and most use pulsed lavage to deliver the fluid. Evidence, however, is thin. Only one randomized trial—conducted in revision arthroplasty—found that dilute povidone-iodine lowered early infection risk compared with saline. No randomized evidence exists for irrigation pressure in primary arthroplasty, and related trauma studies offer mixed signals. With current practice shaped largely by habit and theory, stronger trials are needed to clarify which solutions and pressures truly improve outcomes.