Can Iodophor-Impregnated Drapes be used in patients with Iodine-Related Allergies?

The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes.

A retrospective case series was conducted of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. Draping technique involved application of a skin preparation solution at the discretion of the treating surgeon with layered draping utilizing nonpermeable, adhesive U drapes, followed by single-use top drapes. The iodophor-impregnated adhesive drape was then applied to the surgical site covering all remaining exposed skin. 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor impregnated drape.

Key findings of the study were:

• Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine.

• Sixteen patients had a cluster of iodine-related allergies.

• There were no intraoperative reports of an allergic reaction to this drape.

• There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery.

The authors concluded that - “Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodophor-impregnated adhesive drapes in these patients. Patients with documented allergies to povidone iodine, as distinct from ‘iodine’, shellfish, or ICM should be considered for patch testing prior to proceeding with the utilization of iodophor incise drapes until further research can confirm safety in these patients.” 

Further reading:

The Use of Iodophor-Impregnated Drapes in Patients With Iodine-Related Allergies: A Case Series and Review of the Literature

Andrew Fraval, Nicolina Zappley et al

Arthroplasty Today 23 (2023) 101201

https://doi.org/10.1016/j.artd.2023.101201