Department of Orthopedic Surgery, OCON Center for Orthopaedic Surgery, Hengelo, The Netherlands.
Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
J Arthroplasty. 2019 Jan;34(1):175-182. doi: 10.1016/j.arth.2018.08.034. Epub 2018 Sep 3.
Persistent wound drainage after total joint arthroplasty (TJA) is an important complication with potential substantial adverse consequences, in particular periprosthetic joint infection.
This review evaluated the available literature regarding several issues in the field of persistent wound drainage after TJA and offers a classification of persistent wound drainage and an algorithmic approach to the decision-making process.
Available literature addressing the diagnosis and treatment of persistent wound drainage after TJA is scarce and an evidence-based clinical guideline is lacking. This is partially caused by the absence of a universally accepted definition of persistent wound drainage. In patients with persistent wound drainage, clinical signs and serological tests can be helpful in the diagnosis of a developing infection. Regarding the treatment of persistent wound drainage, nonsurgical treatment consists of absorbent dressings, pressure bandages, and temporary joint immobilization. Surgical treatment is advised when wound drainage persists for more than 5-7 days and consists of open debridement with irrigation and exchange of modular components and antimicrobial treatment.
Based on this literature review, we proposed a classification and algorithmic approach for the management of patients with persistent wound drainage after TJA. Hopefully, this offers the orthopedic surgeon a practical clinical guideline by finding the right balance between overtreatment and undertreatment, weighing the risks and benefits. However, this classification and algorithmic approach should first be evaluated in a prospective trial.
全关节置换术后持续性伤口引流（TJA）是一种重要的并发症，可能会产生严重的不良后果，特别是假体周围关节感染。
本综述评估了全关节置换术后持续性伤口引流领域的现有文献，并提供了一种持续性伤口引流的分类和决策过程的算法方法。
目前针对全关节置换术后持续性伤口引流的诊断和治疗的文献很少，缺乏循证临床指南。这部分是由于缺乏普遍接受的持续性伤口引流定义所致。对于持续性伤口引流的患者，临床体征和血清学检查有助于诊断感染的发生。对于持续性伤口引流的治疗，非手术治疗包括吸收性敷料、加压绷带和临时关节固定。当伤口引流持续 5-7 天以上时，建议进行手术治疗，包括开放性清创术、灌洗、更换模块化组件和抗菌治疗。
基于这项文献综述，我们提出了一种用于管理全关节置换术后持续性伤口引流患者的分类和算法方法。希望这为骨科医生提供了一种实用的临床指南，在过度治疗和治疗不足之间找到适当的平衡，权衡利弊。然而，这种分类和算法方法应首先在前瞻性试验中进行评估。
