Management of the Leaky Wound After Arthroplasty: A Review

Abstract

Total knee and hip arthroplasty are widely performed surgeries for end stage osteoarthritis with highly successful outcomes. However, prolonged postsurgical wound drainage leads to slower healing and predisposes to periprosthetic joint infection. Persistent wound discharge after joint arthroplasty affects patient satisfaction and outcome measures, can cause unexplained re-admissions, and increases the cost burden on the health system. Preventive measures are crucial and include preoperative nutritional assessment, achieving adequate hemostasis, minimizing dead spaces and watertight wound closure. Monitoring these patients with serial C-reactive protein levels is strongly recommended. Many management strategies have been described for such complications, including cessation of deep venous thrombosis prophylaxis, dressings and wound care, antimicrobial therapy, surgical washout and polyethylene insert replacement. However, these conditions are not addressed thoroughly in the literature and optimal management protocol for such complications is still lacking. This article aimed to review the best available literature to date and summarize the findings to help physicians treating these wounds develop objective guidelines in identifying and managing such conditions.