J Bone Jt Infect 2017; 2(4):202-207. doi:10.7150/jbji.22327

Research Paper

Managing persistent wound leakage after total knee and hip arthroplasty. Results of a nationwide survey among Dutch orthopaedic surgeons

Frank-Christiaan Wagenaar*1✉, Claudia A.M. Löwik*2, Martin Stevens2, Sjoerd K. Bulstra2, Yvette Pronk3, Inge van den Akker-Scheek2, Marjan Wouthuyzen-Bakker4, Rob G.H.H. Nelissen5, Rudolf W. Poolman6, Walter van der Weegen7, Paul C. Jutte2 on behalf of the LEAK study group

1. Department of Orthopaedics, OCON, Center for Orthopaedic Surgery, Hengelo, The Netherlands
2. Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
3. Research Department, Kliniek Viasana, Mill, The Netherlands
4. Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
5. Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
6. Department of Orthopaedics, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
7. Department of Orthopaedics, Sint Anna Ziekenhuis, Geldrop, The Netherlands
* Frank-Christiaan B.M. Wagenaar and Claudia A.M. Löwik share a joined first authorship.

Abstract

Background: Persistent wound leakage after joint arthroplasty is a scantily investigated topic, despite the claimed relation with a higher risk of periprosthetic joint infection. This results in a lack of evidence-based clinical guidelines for the diagnosis and treatment of persistent wound leakage after joint arthroplasty. Without such guideline, clinical practice in orthopaedic hospitals varies widely. In preparation of a nationwide multicenter randomized controlled trial on the optimal treatment of persistent wound leakage, we evaluated current Dutch orthopaedic care for persistent wound leakage after joint arthroplasty.

Methods: We conducted a questionnaire-based online survey among all 700 members of the Netherlands Orthopaedic Association, consisting of 23 questions on the definition, classification, diagnosis and treatment of persistent wound leakage after joint arthroplasty.

Results: The questionnaire was completed by 127 respondents, representing 68% of the Dutch hospitals that perform orthopaedic surgery. The results showed wide variation in the classification, definition, diagnosis and treatment of persistent wound leakage among Dutch orthopaedic surgeons. 56.7% of the respondents used a protocol for diagnosis and treatment of persistent wound leakage, but only 26.8% utilized the protocol in every patient. Most respondents (59.1%) reported a maximum period of persistent wound leakage before starting non-surgical treatment of 3 to 7 days after index surgery and 44.1% of respondents reported a maximum period of wound leakage of 10 days before converting to surgical treatment.

Conclusions: The wide variety in clinical practice underscores the importance of developing an evidence-based clinical guideline for the diagnosis and treatment of persistent wound leakage after joint arthroplasty. To this end, a nationwide multicenter randomized controlled trial will be conducted in the Netherlands, which may provide evidence on this important and poorly understood topic.

Keywords: Periprosthetic joint infection, wound leakage, wound drainage, arthroplasty, DAIR

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How to cite this article:
Wagenaar FC, Löwik CAM, Stevens M, Bulstra SK, Pronk Y, Akker-Scheek Ivd, Wouthuyzen-Bakker M, Nelissen RGHH, Poolman RW, van der Weegen W, Jutte PC. Managing persistent wound leakage after total knee and hip arthroplasty. Results of a nationwide survey among Dutch orthopaedic surgeons. J Bone Jt Infect 2017; 2(4):202-207. doi:10.7150/jbji.22327. Available from http://www.jbji.net/v02p0202.htm