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Periprosthetic Joint InfectionPhase 3PREVENT-ITNCT05084378

Evaluation of Emerging New Treatments for Infection Prevention in Total Joint Replacement

A Phase 3 study testing Povidone-Iodine Lavage Solution, Chlorhexidine Lavage Solution and Topical Antibiotic in people with Periprosthetic Joint Infection and Draining Wound, run by McMaster University at 6 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

At the end of total joint replacement (TJR) surgery, surgeons wash and clean the surgical wound. This is done to lower the risk of infections. Currently, most surgeons use saline to wash the surgical wound and do not place antibiotics in the wound . Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Povidone-Iodine Lavage Solution, Chlorhexidine Lavage Solution and Topical Antibiotic
Could I receive a placebo?
No, everyone receives an active treatment
How many people
495 participants
Where
6 sitesin 2 countries
Study dates
11 Mar 2022to 28 Oct 2024
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients 18 years of age or older.
  • Undergoing primary or revision TJR.
  • Informed consent obtained.

Who cannot join

  • Received antibiotics for any reason in the two weeks prior to their TJR.
  • Chronic or acute infection at or near the TJR site.
  • Prior history of PJI.
  • Undergoing surgery for a diagnosis of a fracture.
  • Open wounds on affected limb.
  • Undergoing bilateral TJR.
Show all 16Show fewer
  • Medical contraindication to povidone-iodine.
  • Medical contraindication to chlorhexidine.
  • Medical contraindication to vancomycin.
  • Current or anticipated incarceration.
  • Terminal illness with expected survival less than 90 days.
  • Currently enrolled in a study that does not permit co-enrollment.
  • Unable to obtain informed consent due to language barriers.
  • Problems, in the judgment of study personnel, with maintaining follow-up with the patient.
  • Prior enrollment in the trial.
  • Other reason to exclude the patient, as approved by the Methods Centre.

Trial locations and contacts

6 sites in 2 countries.

6 sites in 2 countries

Canada4 sites
  • St. Joseph's Healthcare

    Hamilton, Ontario, L8N4A6

  • Hamilton Health Sciences- Juravinkski Hospital

    Hamilton, Ontario, L8V 1C3

  • Montreal General Hospital

    Montreal, Quebec

  • St. Mary's Hospital

    Montreal, Quebec

Other trials in Canada

Spain2 sites
  • Hospital Clinic Barcelona

    Barcelona

  • Vall d'Hebron University Hospital

    Barcelona

Other trials in Spain

About this study

Official title: Prospective Randomized Evaluation of Emerging Novel Treatments for Infection Prophylaxis in Total Joint Replacement: A Pilot Study

At the end of total joint replacement (TJR) surgery, surgeons wash and clean the surgical wound. This is done to lower the risk of infections. Currently, most surgeons use saline to wash the surgical wound and do not place antibiotics in the wound . However, some recent studies have shown that using povidone-iodine and chlorhexidine-based solutions (both are types of antiseptics) to wash the surgical site and placing antibiotics directly into the wound may be effective in reducing infections in TJR surgery compared to saline and no antibiotics. However, no study has determined which solution is better at reducing the number of infections in patients undergoing TJR. The investigators also do not know if the addition of antibiotics applied to the wound will decrease infections. Currently, there are no surgical guidelines around infection prevention in total joint replacement. A large scale, multi-site, pragmatic 3 x 2 factorial randomized controlled trial is need that compares these six treatment groups. However, before this, a smaller pilot study must be conducted to determine the feasibility of a larger study. PREVENT-iT will address these important gaps in knowledge and clinical practice.

Read the detailed description

The investigators propose a pilot study that will determine the feasibility of a definitive trial that compares irrigation fluids and topical antimicrobials to reduce the risk of wound complications requiring reoperation in patients undergoing primary or aseptic revision hip or knee TJR.

In the pilot phase, the investigators will compare three irrigation fluids (povidone-iodine lavage, chlorohexidine lavage, and normal saline) and the investigators will compare the use of vancomycin powder versus no powder in a 3 x 2 factorial RCT design.

Therefore, eligible and consenting participants will be randomized to one of six treatment groups:

  1. Povidone-iodine lavage and local antibiotics
  2. Chlorhexidine lavage and local antibiotics
  3. Normal saline lavage and local antibiotics
  4. Povidone-iodine lavage with no local antibiotics
  5. Chlorhexidine lavage with no local antibiotics
  6. Normal saline lavage with no local antibiotics

Study participants will be assessed at regular intervals in the one year following their TJR. The primary clinical outcome is PWD or PJI requiring reoperation within 90 days of TJR. The secondary clinical outcome is PJI within 12 months of TJR.

The time frame of 90 days was selected for the primary clinical endpoint (any reoperation for PWD or PJI) for the pilot phase of this study because the interventions may have a profound impact within the first three months after TJR. Measuring the primary outcomes at this time will allow the study team to examine any acute and early outcomes related to the intervention. This will also provide the study team with the opportunity to identify any potential problems with the interventions.

The one-year timeframe for the secondary clinical endpoint (PJI) was selected for the pilot phase of this study because the majority of PJIs are likely to be diagnosed with one year of TJR surgery. This time frame will allow the study team to record and analyze most of the PJIs, and like the primary outcomes, it will allow for the examination of early outcomes, and any potential problems with the treatments.

The investigators hypothesize the following:

  1. Patients who have their surgical wound irrigated with either povidone-iodine or chlorhexidine will have a significantly lower rate of PWD and PJI requiring reoperation compared to patients who have their wound irrigated with saline.
  2. Patients who have their surgical wound irrigated with povidone-iodine will have similar rates of PWD and PJI requiring reoperation as compared to patients treated with chlorohexidine.
  3. Patients who receive topical vancomycin will have a significantly lower rate of PWD and PJI requiring reoperation compared to patients who did not receive topical antibiotics.
  4. Patients who have their surgical wound irrigated with either povidone-iodine or chlorhexidine will have a significantly lower rate of PJI compared to patients who have their wound irrigated with saline.
  5. Patients who have their surgical wound irrigated with povidone-iodine will have similar rates of PJI compared to patients treated with chlorohexidine.
  6. Patients who receive topical vancomycin will have a significantly lower rate of PJIs compared to patients who did not receive topical antibiotics.

Participants will be followed for one year for safety and in anticipation that the pilot study may continue into the definitive trial phase. At the conclusion of the pilot study, the Principal Investigators will determine whether to:

  • Continue with the existing protocol and proceed with the definitive trial.
  • Revise the protocol based on lessons learned from the pilot phase.
  • Conclude that the trial is not feasible.

The feasibility objectives in our pilot study do not lend themselves to traditional quantitative sample size calculations. The sample size for the pilot study will be 500 patients. This sample size for the pilot study was chosen in consideration of the following items:

  • Due to the low event rate of PJI/PWD in this population, our initial sample size estimates suggest that the investigators will need a sample size of approximately 20,000 patients for the definitive trial. Given the large size of the definitive trial, a larger than usual sample size of 500 participants is needed and will represent approximately 2.5% of the sample size of a definitive trial. This will provide sufficient data to inform feasibility, sample size, and refine the design of the proposed definitive trial.
  • As the definitive trial will have a large sample size and will be international in scale, the investigators need to demonstrate to our potential funding agencies our ability to enroll a high number of patients and maintain high level data collection and follow-up.
  • The investigators also require a sufficient number of events in the pilot study to establish the adjudication process. A sample size of 500 participants will allow for the reporting and adjudication of approximately 15 events.

Statistical Methods:

Analysis Plan Overview The analysis and reporting of results will follow the CONSORT guidelines for reporting of randomized pilot and feasibility trials. The investigators will use descriptive statistics, reported as count and percentage or mean and standard deviation depending on the type of variable to summarize the results of our feasibility objectives of this pilot study. Feasibility outcomes will be based on descriptive statistics reported as % (95% CI).

The analyses will be conducted using R (Vienna, Austria).

Being tested
Povidone-Iodine Lavage Solution, Chlorhexidine Lavage Solution, Topical Antibiotic, Saline Lavage Solution

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Povidone-Iodine Lavage SolutionDrug

    0.35% povidone-iodine solution mixed with 1 litre of sterile isotonic saline solution. Commercially available products with 0.35% povidone-iodine and sterile isotonic saline solution may also be used.

  • Chlorhexidine Lavage SolutionDrug

    0.05% chlorhexidine solution mixed with 1 litre of sterile isotonic saline solution. Commercially available products with 0.05% chlorhexidine and sterile isotonic saline may also be used.

  • Topical AntibioticDrug

    2 grams Vancomycin powder

  • Saline Lavage SolutionDrug

    1 litre of sterile isotonic saline

Study groups in NCT05084378
Study groupRoleWhat they receive
Povidone-iodine Lavage and Local AntibioticsExperimental1 litre of 0.35% povidone-iodine lavage solution will be used. 2 grams of Vancomycin antibiotic powder will be applied to the deep joint (deep to fascia) following lavage solution and immediately prior to closure.
Receives: Drug: Povidone-Iodine Lavage Solution; Drug: Topical Antibiotic
Chlorhexidine Lavage and Local AntibioticsExperimental1 litre of 0.05% chlorhexidine lavage solution will be used. 2 grams of Vancomycin antibiotic powder will be applied to the deep joint (deep to fascia) following lavage solution and immediately prior to closure.
Receives: Drug: Chlorhexidine Lavage Solution; Drug: Topical Antibiotic
Normal Saline Lavage and Local AntibioticsExperimental1 litre of sterile isotonic saline solution will be used. 2 grams of Vancomycin antibiotic powder will be applied to the deep joint (deep to fascia) following lavage solution and immediately prior to closure.
Receives: Drug: Topical Antibiotic; Drug: Saline Lavage Solution
Povidone-iodine Lavage Solution with no Local AntibioticsExperimental1 litre of 0.35% povidone-iodine lavage solution will be used immediately prior to closure.
Receives: Drug: Povidone-Iodine Lavage Solution
Chlorhexidine Lavage Solution with no Local AntibioticsExperimental1 litre of 0.05% chlorhexidine lavage solution will be used immediately prior to closure.
Receives: Drug: Chlorhexidine Lavage Solution
Normal Saline Lavage with no Local AntibioticsActive comparator1 litre of sterile isotonic saline solution will be used immediately prior to closure.
Receives: Drug: Saline Lavage Solution

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Feasibility of a Definitive Trial based on the following criteria domains: 1) Participant Enrollment, 2) Administration of Treatments, 3) Data Collection Methods, and 4)Compliance with the Protocol.

    Each domain will be interpreted via a "traffic light" approach, in which "green" will indicate moving forward as is with the definitive trial, "yellow" will mean proceeding with some modifications, and "red" will indicate that the definitive trial is not feasible. Feasibility criteria will be monitored over the course of the pilot study and modifications will be made to the protocol during the pilot phase to increase feasibility.

    Measured: 2 - 2.5 years

Secondary outcomes (1)
  1. Persistent Wound Drainage (PWD) and Periprosthetic Joint Infections (PJI) requiring reoperation

    Incidence of PWD and PJI events requiring reoperation will be measured. PWD will be defined as a non-infectious disturbance in wound healing of short duration that occurs during the days following TJR. PJI will be defined by the Musculoskeletal Infection Society (MSIS) criteria for diagnosis of PJI. Reoperations will include, but are not limited to, irrigation, debridement, liner exchange, and implant exchange. Reoperations for hardware complications or fracture will not be considered study events. A blinded Adjudication Committee will review all reported reoperations to confirm that they meet the criteria for being a study event.

    Measured: Within 90 days of the Total Joint Replacement Surgery

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted19 Oct 2021
  2. Study start11 Mar 2022
  3. Primary completion4 Aug 2024
  4. Study completion28 Oct 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Factorial
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
495 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05084378
Sponsor's protocol ID
PREVENT-IT
Acronym
PREVENT-IT
Status last verified
May 2025
First submitted
22 Aug 2021
Last updated
7 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Povidone-Iodine Lavage Solution, Chlorhexidine Lavage Solution and Topical Antibiotic in people with Periprosthetic Joint Infection and Draining Wound, run by McMaster University at 6 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in Canada, Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Feasibility of a Definitive Trial based on the following criteria domains: 1) Participant Enrollment, 2) Administration of Treatments, 3) Data Collection Methods, and 4)Compliance with the Protocol. (time frame: 2 - 2.5 years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2026.

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