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Volume 13
Journal of Orthopaedics Trauma Surgery and Related Research
ISSN: 1897-2276
Orthopedics 2018
March 08-09, 2018
March 08-09, 2018 London, UK
10
th
International Conference on
Orthopedics, Trauma and Rheumatology
How to manage persistent draining wounds after total joint arthroplasty
Ali Oliashirazi
Marshall University, USA
Introduction & Aim:
Persistent wound drainage has been recognized as one of the major risk factors of Peri-prosthetic Joint
Infection (PJI). Currently, there is no consensus on the management protocol for patients who develop wound drainage after Total
Joint Arthroplasty (TJA). The objective of our study was to describe a multimodal protocol for managing draining wounds after TJA
and assess the outcomes.
Methods:
We conducted a retrospective study of 4,873 primary TJAs performed between 2008 and 2015. Using an institutional
database, patients with persistent wound drainage (>48 hours) were identified. A review of the medical records was then performed to
confirm persistent drainage. Draining wounds were first managed by instituting local wound care measures. In patients that drainage
persisted over 7 days, a superficial irrigation and debridement (I and D) was performed if the fascia was intact and if the fascia was
not intact modular parts were exchanged. TJAs that underwent subsequent I&D, revision surgery, or developed PJI within one year
were identified.
Results:
The overall rate of persistent wound drainage was 6.2% (302/4, 873). 65% (196/302) of patients with draining wounds did
not require any surgical procedures. Of the patients with persistent drainage, 9.8% underwent I and D and 25.1% underwent revision
arthroplasty. Moreover, 15.9% of these patients developed PJI within one year. Compared to those without wound drainage, TJAs
complicated by wound drainage demonstrated an odds ratio of 16.9 (95% CI: 9.1-31.6) for developing PJI and 18.0 (95% CI: 11.3-
28.7) for undergoing subsequent surgery.
Conclusion:
Wound drainage after TJA is a major risk factor for subsequent PJI and therefore, proper management of these patients
has paramount importance. Our results demonstrated that drainage ceased spontaneously in 65% of the patients with local wound
care measures alone. Wounds with persistent drainage were at substantially higher risk for PJI than those that healed uneventfully.
Biography
Ali Oliashirazi is a Professor and Chair of the Department of Orthopedic Surgery at Joan C. Edwards School of Medicine at Marshall University. He is also the
Vice Dean for Business Development and External Affairs at the School of Medicine. He has completed his Orthopedic Training at the prestigious Mayo Clinic
in Rochester, Minnesota. He has passion and expertise in joint replacement surgery, in particular knee replacement surgeries. He lectures extensively, and his
research has been presented both nationally and internationally. He is a board certified Orthopedic Surgeon, a Fellow of the American Academy of Orthopedic
Surgery and a Member of the American Association of Hip and Knee Surgeons.
oliashirazi@marshall.eduAli Oliashirazi, J Orthop Trauma Surg Rel Res 2018, Volume 13