Is early operative treatment for wound complications beneficial for preventing major component revision after TKA? A systematic review

Abstract

BackgroundWound complications following TKA can progress to deep infection and compromise implant survivorship and clinical outcomes. However, it remains unclear whether early wound complications must undergo immediate surgical debridement or whether a trial of conservative treatment provides comparable outcomes. This study evaluates the rates of subsequent return to the operating room, deep infection, major reoperations and implant survivorship for early versus delayed operative management of superficial wound complications following TKA. Materials and methodsWe performed a systematic review of the literature indexed on PubMed and Embase and identified 14 studies which reported implant survivorship and deep infection rates following TKA wound complications. The data were aggregated to compare rates of secondary return to the OR, deep infection, and explants in patients with superficial wound complications following TKA managed with either early operative intervention versus conservative treatment. ResultsThe mean time to operative intervention was 17.7 days in the early operative group, compared to 12.8 days in the conservative management group. Rates of subsequent deep prosthetic joint infection were similar between the 2 groups (9.2% vs 5.2%, RR = 1.79, p = 0.098). However, there was a significant decrease in subsequent return to the OR for patients undergoing early surgical debridement compared to delayed surgical intervention (12.1% vs. 19.9%, RR = 0.609, p = 0.049). There were no significant differences between groups in terms of major revision rate (9.2% vs 4.6%, RR = 2.01 p = 0.053) or implant survivorship (95.7% vs. 95.4%, RR = 1.00, p = 0.869). ConclusionsIn wound complications following TKA, short delays in surgical management did not affect the overall rates of deep infection, major revision surgery, or implant survivorship. However, initial conservative treatment was associated with higher failure rates requiring subsequent return to the OR. We recommend that surgeons have a low threshold to return to the OR for early aggressive management of wound complications following TKA.