PurposePeriprosthetic joint infection (PJI) is a serious complication with total joint arthroplasty (TJA), that necessitates reoperation. Pre-closure irrigation with dilute povidone-iodine (PI) is among the preventive measures, but its efficiency is still controversial. As a result, the focus of this systematic review and meta-analysis is on the effect of dilute PI wound irrigation in the prevention of PJI following TJA.MethodsWe systematically reviewed and analyzed articles that compared PI with other agents in terms of PJI rate after TJA, searching Medline, Scopus, Web of science, and Cochrane databases. A number of 13 papers including 63,950 patients in total, were finally considered in qualitative and quantitative assessments. We have also further assessed review articles.ResultsIn comparison with normal saline (NS), PI reduced post-operative infection rate (OR: 0.44; CI 95%: 0.34–0.56). However, there was no difference between PI and chlorhexidine (CHG) (OR: 1.61; CI 95%: 0.83–3.09)) or undetermined comparators (OR: 1.08; CI 95%: 0.67–1.76).ConclusionPI irrigation seems an efficient preventive measure for post-operative PJI and would seem to be the most feasible for TJA protocol.