The draining surgical wound post total hip and knee arthroplasty: what are my options? A narrative review

Abstract

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are successful orthopaedic procedures with an ever-increasing demand annually worldwide, and persistent wound drainage (PWD) is a well-known complication following these procedures. Despite many definitions for PWD having been proposed, a validated description remains elusive. PWD is a risk factor for periprosthetic joint infection (PJI). PJI is a devastating complication of THA and TKA, and a leading cause of revision surgery with dramatic morbidity and mortality and a significant burden on health socioeconomics. Prevention of PJI has become an essential focus in THA and TKA. Understanding the pathophysiology, risk factors and subsequent management of PWD may aid in decreasing the rate of PJI. Risk factors of PWD can be divided into modifiable and non-modifiable patient risk factors, pharmacological and surgical risk factors. No gold standard treatment protocol to address PWD exists; however, non-operative options progressing to surgical interventions have been described. The aim of this study was to review the current literature regarding PWD and consolidate the risk factors and management strategies available. Cite this article: EFORT Open Rev 2021;6:872-880. DOI: 10.1302/2058-5241.6.200054

Pharmacological thromboprophylaxis as a risk factor for early periprosthetic joint infection following primary total joint arthroplasty

“…However, risk of infection associated with pharmacological VTE prophylaxis was another important issue that has not been well evaluated. Pharmacological VTE prophylaxis might lead to (1) postoperative hematoma, which acts as a nidus for bacteria to settle, and (2) prolonged wound drainage, which increases wound tension, bypasses the natural barrier of the skin, increases risk of wound dehiscence and provides a retrograde pathway for pathogens 8 , 11 , 16 , but whether the pharmacological agents for prophylaxis would increase the risk of infection following TJA procedures was inconsistent 7 . The rates of SSC were generally higher in studies with routine pharmacological VTE prophylaxis than those studies in which pharmacological VTE prophylaxis were not routinely administered (0.4–13.3% vs. 1.5–3.6%) 17 – 20 .…”

Clinical and laboratory predictors for prosthetic joint infection within the first postoperative days following primary total hip and knee arthroplasty

“…A PWD is a well-known complication following THA/TKA and is a recognized risk factor for PJI [ 25 ]. It is, however, unclear whether PWD is the cause or the consequence of a PJI.…”

“…It is, however, unclear whether PWD is the cause or the consequence of a PJI. Despite many definitions for PWD having been proposed, a validated description remains elusive, and evidence-based clinical guidelines for the diagnosis and treatment of PWD in TJA are still lacking [ 25 ]. Each extra day of PWD carries a high additional risk of wound infection after THA/TKA [ 25 ].…”

Neutrophil heterogeneity and aging: implications for COVID-19 and wound healing

“…Insufficient intake of protein, for example, can hinder tissue synthesis, while deficiencies in vitamins and minerals can disrupt collagen formation and immune response ( 190 , 191 ), both crucial for wound recovery. Hence, malnutrition not only delays wound healing but also escalates the risk of complications, such as infection or wound dehiscence ( 192 , 193 ). This understanding underscores the need for thorough nutritional assessment and appropriate dietary interventions in managing wound care for COVID-19 patient ( 194 , 195 ).…”