Treatment of complicated wound healing after total joint arthroplasty is controversial. What exactly constitutes prolonged wound drainage is matter of debate and recommendations to manage it vary considerably. Nonoperative measures are often recommended. If drainage persists, surgery may be indicated. To further intricate decision-making, differentiating superficial from deep surgical site infection is also controversial and inherently complex. Specific cutoffs for synovial fluid leukocyte count and blood C-reactive protein (CRP) in the acute stage have been suggested as a way to superficial infection requiring superficial wound washout from deep infection requiring a formal debridement, antibiotics and implant retention (DAIR) procedure. The goal of this study is to analyze clinical and laboratory findings of an institutional protocol of “aggressively” proceeding with formal DAIR in all patients with complicated wound healing Our indications for DAIR in suspected acute postoperative periprosthetic joint infection (PJI) are: 1)prolonged wound drainage and CRP upward trend after day-3; 2)persistent wound drainage by day-10 regardless of CRP; 3)wound healing disturbance (e.g. “superficial” infection, “superficial” skin necrosis) anytime in early postoperative weeks. We retrospectively evaluated patients undergoing DAIR in the first 60 postoperative days between 2014–2018. Patients without multiple deep tissue cultures obtained intraoperative were excluded. Deep infection was defined by at least two positive deep tissue cultures or one positive deep culture and positive leukocyte count (>10,000 cells/mL or >90% PMN).Aim
Method
The purpose of this study is to evaluate the safety profile and impact on functional results of surgical debridement performed in the early postoperative by comparing them with patients that undergone uncomplicated total joint arthroplasty. This is a retrospective case-control study. Patients that underwent debridement with prosthesis preservation for suspected acute postoperative infection of total hip or knee arthroplasty between 2010–2014 were included. Controls were randomly selected (1:2 ratio) from a list of primary arthroplasty patients in the same time period matching for articulation, age, gender, ASA score, BMI and follow-up time. Infection status, success of treatment and medical-surgical complications were investigated and all patients were assessed using Hip disability and Osteoarthritis Outcome Score(HOOS) or Knee injury and Osteoarthritis Outcome Score(KOOS).Aim
Method
