Wound drainage after arthroplasty and prediction of acute prosthetic joint infection: prospective data from a multicentre cohort study using a telemonitoring app

Abstract

Abstract. Background: Differentiation between uncomplicated and complicated postoperative wound drainage after arthroplasty is crucial to prevent unnecessary reoperation. Prospective data about the duration and amount of postoperative wound drainage in patients with and without prosthetic joint infection (PJI) are currently absent. Methods: A multicentre cohort study was conducted to assess the duration and amount of wound drainage in patients after arthroplasty. During 30 postoperative days after arthroplasty, patients recorded their wound status in a previously developed wound care app and graded the amount of wound drainage on a 5-point scale. Data about PJI in the follow-up period were extracted from the patient files. Results: Of the 1019 included patients, 16 patients (1.6 %) developed a PJI. Minor wound drainage decreased from the first to the fourth postoperative week from 50 % to 3 %. Both moderate to severe wound drainage in the third week and newly developed wound drainage in the second week after a week without drainage were strongly associated with PJI (odds ratio (OR) 103.23, 95 % confidence interval (CI) 26.08 to 408.57, OR 80.71, 95 % CI 9.12 to 714.52, respectively). The positive predictive value (PPV) for PJI was 83 % for moderate to heavy wound drainage in the third week. Conclusion: Moderate to heavy wound drainage and persistent wound drainage were strongly associated with PJI. The PPV of wound drainage for PJI was high for moderate to heavy drainage in the third week but was low for drainage in the first week. Therefore, additional parameters are needed to guide the decision to reoperate on patients for suspected acute PJI.

How good are surgeons at disclosing periprosthetic joint infection at the time of revision, based on pre- and intra-operative assessment? A study on 16,922 primary total hip arthroplasties reported to the Norwegian Arthroplasty Register

“…A recent Dutch study showed strong association between wound drainage and PJI from the 2nd week after surgery [ 16 ].…”

“…Prolonged wound drainage has been shown to be an independent risk factor for the development of PJI, as it represents a pathway for bacteria to deeper tissues [ 16 , 17 ]. Therefore, prolonged wound drainage could represent imminent PJI, and it is recommended to approach it with surgical measures, including debridement, thorough lavage, and exchange of modular parts.…”

Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association

“…Surgeons may also perform and report DAIR due to prolonged wound drainage to “save” the implant, and report this to the register as revision due to infection. This revision strategy is well motivated due to the strong association between prolonged wound drainage, superficial SSIs, and PJI [ 24 , 25 ]. As mentioned earlier, the reported diagnosis is not dependent on bacterial cultures of tissue samples collected during the revision and, hence, there may be a certain level of misdiagnosis.…”

Prosthetic joint infection diagnosis in an age of changing clinical patterns of infection and new technologies

“…In a recent prospective study, 1019 patients recorded their wound status daily for 30 days after elective joint replacement. Sixteen of them developed a proven PJI, and the strongest predictors were persistent wound drainage in the third post‐operative week, and newly developed wound drainage following a week of no wound drainage 15 . A discharging wound on or after the third post‐operative week should therefore be considered evidence of a PJI until proven otherwise.…”