Procrastination of Wound Drainage and Malnutrition Affect the Outcome of Joint Arthroplasty

Jaberi, Fereidoon Mojtahed; Parvızı, Javad; Haytmanek, C. Thomas; Joshi, Anand; Purtill, James J.

doi:10.1007/s11999-008-0214-7

Cited by 189 publications

(145 citation statements)

References 12 publications

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“…The role of nutrition in wound healing and complications in orthopedic surgery has been identified in previous studies [6][7][8][9][10][11]14,29]. Despite this association, application of laboratory screening for malnutrition remains poorly defined and cumbersome for surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…In the orthopedic literature there are multiple studies demonstrating poor outcomes in malnourished patients undergoing elective joint arthroplasty, hip fractures and amputations [5][6][7][8][9][10]. The influence of malnutrition on the incidence of superficial or deep infection and wound related problems has also been the focus of many studies [11][12][13]. In one study evaluating total knee revisions with wound healing issues, over 88% of wound complications involved malnourished patients [14].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Malnutrition on Patients Undergoing Elective Joint Arthroplasty

Huang

Greenky

Kerr

et al. 2013

The Journal of Arthroplasty

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162

146

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Malnutrition on Patients Undergoing Elective Joint Arthroplasty

Huang

Greenky

Kerr

et al. 2013

The Journal of Arthroplasty

Self Cite

162

146

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“…Periprosthetic joint infections have known modifiable and nonmodifiable risk factors [12]. Established modifiable risk factors include allogenic blood transfusion, excessive anticoagulation treatment, obesity, malnutrition, simultaneous bilateral surgery, alcoholism, use of surgical drain and long postoperative urinary catheterisation [12][13][14][15][16]. Interventions to prevent or correct these modifiable risk factors have the potential to lower the periprosthetic joint infection rate.…”

Section: Introductionmentioning

confidence: 99%

Is there an association between periprosthetic joint infection and low vitamin D levels?

Maier

Horas

Seeger

et al. 2014

International Orthopaedics (SICOT)

102

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Purpose Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection. Methods Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n=50) or aseptic loosening of the prosthesis (n=31) scheduled to undergo revision surgery. The prevalence of normal (>30 ng/ml), insufficient (20-30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined. Results All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p=0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p<0.001). In addition, we found a significant difference (p<0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening. Conclusion We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.

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“…Postoperative incisional drainage reportedly occurs in 1% to 3% of patients undergoing primary total joint arthroplasty [4,22]. Persistent wound drainage lasting greater than 48 hours after hip arthroplasty is a risk factor for periprosthetic joint infection (PJI) [4,14,22].…”

Section: Introductionmentioning

confidence: 99%

“…Persistent wound drainage lasting greater than 48 hours after hip arthroplasty is a risk factor for periprosthetic joint infection (PJI) [4,14,22]. Patel et al [10] estimated that each day of persistent wound drainage increases the risk of infection by 42%.…”

Section: Introductionmentioning

confidence: 99%

Negative Pressure Wound Therapy Is Associated With Resolution of Incisional Drainage in Most Wounds After Hip Arthroplasty

Hansen

Durinka

Costanzo

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty. Questions/purposes We determined (1) the rate of wound complications related to use of NPWT for persistent incisional drainage after hip arthroplasty; (2) the rate of resolution of incisional drainage using this modality; and (3) risk factors for failure of NPWT for this indication. Methods In a pilot study we identified 109 patients in whom NPWT was used after hip arthroplasty for treating postoperative incisional drainage between April 2006 and April 2010. On average, the NPWT was placed on postoperative Day 3 to 4 (range, 2-9 days) and applied for 2 days (range, 1-10 days). We then determined predictors of subsequent surgery. Patients were followed until failure or a minimum of 1 year (average, 29 months; range, 1-62 months). Results Eighty-three patients (76%) had no further surgery and 26 patients (24%) had subsequent surgery: 11 had superficial irrigation and débridement (I&D), 12 had deep I&D with none requiring further surgery, and three ultimately had component removal. Predictors of subsequent surgery included international normalized ratio level greater than 2, greater than one prior hip surgery, and device application greater than 48 hours. There were no wound-related complications associated with NPWT. Conclusions The majority of our patients had cessation of wound drainage with NPWT.

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Procrastination of Wound Drainage and Malnutrition Affect the Outcome of Joint Arthroplasty

Abstract: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 189 publications

References 12 publications

The Effect of Malnutrition on Patients Undergoing Elective Joint Arthroplasty

The Effect of Malnutrition on Patients Undergoing Elective Joint Arthroplasty

Is there an association between periprosthetic joint infection and low vitamin D levels?

Negative Pressure Wound Therapy Is Associated With Resolution of Incisional Drainage in Most Wounds After Hip Arthroplasty

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