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

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.

A Urology Case with Persistant Wound Leakage

“…Based on a general review of definitions in the literature, persistent wound leakage is considered as a leakage that persists for longer than three days (2) . Wagenar et al (3) who investigated this problem more extensively in relation to orthopedic knee surgeries, suggested that persistent wound leakage could not be defined based on a certain number of days. Kibers et al (1) defined persistent wound leakage as 50 cc drainage or that lasting more than 7 days.…”

LEAK study: design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty

“… 26 In preparation of designing this RCT, we performed a survey among Dutch orthopaedic surgeons to evaluate current Dutch orthopaedic care for persistent wound leakage after joint arthroplasty. As only 17.2% of Dutch orthopaedic surgeons started surgical treatment after 5–7 days of wound leakage and 44.1% after 10 days of wound leakage, 11 we decided to perform surgical treatment at day 9–10 after joint arthroplasty.…”

“…Treatment of persistent wound leakage varies considerably among Dutch hospitals, as confirmed recently by a nationwide questionnaire-based survey regarding both non-surgical and surgical treatment modalities. 11 However, these modalities have never been studied comparatively.…”

First results of a uniform regional treatment protocol and registration for acute prosthetic join infection in the South-East of the Netherlands

“…13 Furthermore, a lot of variety exists in the available protocols. 13,14 As national (Dutch) registries are not developed for the registration of PJI but rather focus on implant survival, not all DAIR procedures -even if exchange of modular components took place- are reported in these registries. 13,15 This contributes to the underestimation of the rate of implant-related infections 16,17.…”