Abstract
A Prosthetic Joint infection (PJI) is an orthopedic disaster. There is a direct correlation between persistent wound drainage (>72 hours) and the development of a PJI. It is unknown if early wound drainage (<12 hours) is correlated with PJI.
We included 753 consecutive patients treated with a Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) operated between December 2012 and December 2013. All patients were treated according to our local fast track joint surgery protocol. We retrospectively analyzed the prospectively collected data on wound drainage and PJI.
The diagnosis PJI was established according to the definition by the International Consensus Group on Prosthetic Joint Infections. Per PJI-case, two control-cases were matched on type of surgery (THA or TKA) and day of surgery. Analysed variables were co-morbidities, medication, use of drains, haematoma, wound drainage and dressing changes. Statistical analysis was done using Kaplan Meier logistic regression with statistic significance set at p<0.005.
In 753 included patients, 25 PJI-cases were identified and 50 controls were matched. Cases had significant more wound drainage (88% vs 36% P=0.001)) and wound dressing changes (56% vs 18% P=0.006) in the direct postoperative phase (<12 uur postoperative). Cases had more haematoma (44% vs 10% P=0.005). We found no association between PJI and co-morbidity, medication and use of drains.
We found that wound drainage directly postoperative (<12hr) correlated with PJI. We believe that direct post operative drainage is of crucial importance in the development of PJI and inhibition of drainage offers opportunities for prevention of PJI. The use of tranexamic acid, suction drains and critical evaluation of guidelines for preventing thrombo embolic events all offer reducing the risk on wound drainage and the development of PJI.
