The Impact of an Acute, Traumatic Wound Dehiscence on Clinical Outcomes Following Primary Knee Arthroplasty

Abstract

BackgroundEarly wound healing complications and persistent drainage are associated with an increased risk of infection following knee arthroplasty. However, the scenario in which a patient sustains an acute, traumatic wound dehiscence has not been investigated. The purpose of this study is to determine the outcomes of an acute traumatic wound dehiscence following arthroplasty treated with an urgent irrigation and debridement and primary wound closure. MethodsUsing a single institution's arthroplasty registry, patients sustaining an acute, traumatic wound dehiscence within 30 days of undergoing a primary knee arthroplasty were identified. Patients experiencing chronic wound drainage without injury or a history of prior infection were excluded. Patients were followed for the occurrence of complications and clinical outcomes using the Knee Society Score. ResultsFrom 2006 to 2016, 14 of 25,819 eligible patients (0.05%) were identified as having a traumatic wound dehiscence. The mean time from arthroplasty to wound dehiscence was 9.3 days. All but one patient was treated operatively within 24 hours of dehiscence. Postoperative antibiotics were administered for a mean of 21 days. At a mean of 6.5 years, 6 patients were considered failures (43%) including 2 deep infections, 3 revisions for instability, and 1 patient with a Knee Society Score <60 points. ConclusionDespite emergent incision and drainage and wound closure, patients experiencing an acute traumatic wound dehiscence following knee arthroplasty subsequently exhibit high rates of reoperation for instability, periprosthetic infection, and clinical failure. Further work is required to better understand the optimal modes of treatment for this complication.