Cost-effective Skin Marking in Joint Replacement Surgery: A Comparative Study between Methylene Blue Ink and Commercially Available Skin Markers

Introduction: This study aimed to assess and compare the effectiveness and safety of methylene blue ink and commercially available surgical marker pens in pre-operative skin marking for joint replacement procedures. The objective was to evaluate the visibility of the surgical instruments during the operation and their influence on the occurrence of infections after the surgery, providing valuable information on the practical use and cost-effectiveness.

Materials and methods: This retrospective randomized study involved 150 total cases, which included knee replacements, total hip replacements, and hip hemiarthroplasty performed between 2020 and 2023. The same surgeon conducted all procedures, and the patients were randomly assigned to two groups: One marked with methylene blue ink and the other with a commercially available sterile marker pen. Limb preparation followed an identical protocol for both groups. The primary outcomes assessed were the visibility of markings at the end of the procedure and the incidence of post-operative infections.

Results: The visibility of markings was satisfactory in both groups, with the methylene blue group displaying more pronounced visibility. Importantly, there were no cases of post-operative infections or permanent tattooing attributed to either marking method.

Conclusion: This study demonstrates that both methylene blue ink and commercially available surgical marker pens provide effective skin markings for surgical procedures without increasing the risk of post-operative infections or causing permanent tattooing. Methylene blue ink showed more evident marking post-procedure and ink form remains a cheaper alternative.