Abstract
Wound complications are much more common following knee arthroplasty compared to hip arthroplasty. This is because of the precarious blood supply which contributes to the infection rate which is about twice as high. Many, if not most, infections are related to wound problems. Avoiding wound problems is a critical issue in joint replacement, more so in the knee than the hip. The volume of these procedures is growing rapidly. Infection continues to be a major complication. The incidence is not decreasing and infections are becoming more difficult to treat, because of resistant organisms. Also, the increasing number of procedures in patients with obesity and other risk factors makes wound management a major issue in knee replacement. Many wound problems are avoidable and can be minimised by care to detail by the surgeon.
Salvaging the problem wound is a major issue in total knee replacement currently in order to minimise infection, which remains a major issue and is frequently related to wound healing problems. The first step is identifying the patient at risk and either deferring surgery or optimising the patient to minimise the risk of wound healing problems and subsequent infection. Secondly, is appropriate soft tissue handling with careful attention to choosing the optimal skin incision. Third is taking steps to facilitate primary wound healing and absolutely minimising the risk of persistent drainage, particularly through the very judicious use of anticoagulants. Finally, the delayed wound healing and persistent drainage must be identified early and treated aggressively in order to minimise the risk of infection.
