Presence of superficial wound infection following total joint replacement (TJR) increases risk of deep prosthetic infection and revision surgery. Early identification and management are advocated.

We conducted an audit to identify the number of suspected wound infections, treatment received, and whether diagnosis was supported by microbiological evidence. Early complication data were collected for all TJRs completed in a 12-month period (2012, n=314). Medical records were reviewed for all complications and summarised data were compared with data from 2010/11.

Forty-nine complications were recorded (47 in 2010/11) with increase in number of bacteriologically confirmed wound infections (from 2 to 6) and in number of serious wound infections (n=3).

Review of medical records showed that patients were treated in the community with antibiotics despite lack of objective microbiological evidence. Two of three serious wound infections were preceded by prolonged antibiotic prescription in the community.

Analysis of these results led to a new system for management of suspected wound infection in TJR patients. A ‘wound care card’ is issued at time of discharge and early assessment by a specialist orthopaedic nurse is available. Early results indicate a beneficial effect with potential to improve patient experience and long-term outcome, and to reduce overuse of antibiotics.