Wound Complications after Total Knee Arthroplasty

Vince, Kelly G.; Chivas, Dan; Droll, Kurt P.

doi:10.1016/j.arth.2007.03.014

Cited by 91 publications

(82 citation statements)

References 35 publications

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“…Results have been highly variable and currently there is no consensus on a superior closure method. Physiologically, the most important modifiable factor in wound healing is maintenance of perfusion to the incision site [1,5,14,19]. Therefore, it would be beneficial to know how the closure technique modifies this parameter.…”

Section: Discussionmentioning

confidence: 99%

“…The number of TKAs performed each year is on the rise, and a greater percentage of these patients have comorbidities that can impair wound healing such as diabetes, a history of smoking, previous surgery about the knee, chronic infection, peripheral arterial disease, and anticoagulant or corticosteroid use [7][8][9]14]. These comorbidities in conjunction with relatively thin skin anterior to the knee makes wound complications an issue of growing concern [19,20].…”

Section: Introductionmentioning

confidence: 99%

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The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Wyles

Jacobson

Houdek

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Maintaining robust perfusion is an important physiologic parameter in wound healing. The effect of different closure techniques on wound perfusion after total knee arthroplasty (TKA) has not been established previously and may have implications for wound healing. Questions/purposes We asked whether a running subcuticular, vertical mattress, or skin staple closure technique enables the most robust wound perfusion after TKA as measured by laser-assisted indocyanine green angiography (LA-ICGA) in patients without specific risk factors for wound healing complications. Methods Forty-five patients undergoing primary TKA without comorbidities known to impact wound healing and perfusion were prospectively randomized to receive superficial skin closure with one of the following techniques: (1) running subcuticular (3-0 monofilament); (2) vertical mattress (2-0 nylon); or (3) skin staples. Twenty procedures were performed by RTT, 15 by RJS, and 10 by FHS. All surgeons used an anterior skin incision over the medial third of the patella in combination with a median parapatellar arthrotomy. Perfusion was assessed with a LA-ICGA device and software system immediately after closure to quantify fluorescence. Twenty-seven points were assessed immediately after closure in the operating room in each patient (nine along the incision and nine pairs medial and lateral to the incision). Mean incision perfusion was determined from the nine points along the incision with One of the authors (RJS) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Lifecell Corporation (Branchburg, NJ, USA) in an amount of less than USD 10,000 and Biomet Inc (Warsaw, IN, USA) in an amount of USD 10,000 to USD 100,000. One of the authors (MJT) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DJO Global (Vista, CA, USA) in an amount of less than USD 10,000. One of the authors (RTT) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DePuy Orthopaedics, Inc (Warsaw, IN, USA) in an amount of USD 10,000 to USD 100,000. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. higher values indicating greater blood flow. Mean perfusion impairment was determined by calculating the difference between the nine pairs of surrounding skin and the nine points along the incision with smaller values ind...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Wyles

Jacobson

Houdek

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Therefore, this additional time requirement is mainly a positive factor which results in improved implant alignment. In contrast, the additional time requirement during the learning curve is completely useless: it is caused by unfamiliar workflows and low usability of the navigation devices and hence produces no benefit for the patient; on the contrary, it elevates exclusively perioperative morbidity risks and the costs of the procedure [1,9,10,[22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…However, several investigations have shown that, with respect to the operation time, there is a significant learning curve effect, leading to much longer operation times for untrained surgeons [15][16][17][18][19][20][21]. A prolonged operation time has been associated with an increased incidence of postoperative infections [22], wound complications [23] and venous thromboembolic diseases [24]. In summary, because of these elevated morbidity risks and with a view to the economic situation, attempts should be made to reduce the additional operation time needed for computer navigation.…”

Section: Introductionmentioning

confidence: 99%

Displays mounted on cutting blocks reduce the learning curve in navigated total knee arthroplasty

Schnurr

Eysel

König

2011

Computer Aided Surgery

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The use of computer navigation in total knee arthroplasty (TKA) improves the implant alignment but increases the operation time. Studies have shown that the operation time is further prolonged due to the surgeon's learning curve, and longer operation times have been associated with higher morbidity risks. It has been our hypothesis that an improvement in the human-machine interface might reduce the time required during the learning curve. Accordingly, we asked whether the use of navigation devices with a display fixed on the surgical instruments would reduce the operation time in navigated TKAs performed by navigation beginners.Thirty medical students were randomized and used two navigation devices in rotation: these were the Kolibri Õ device with an external display and the Dash Õ device with a display that was fixed on the cutting blocks. The time for adjustment of the tibial and femoral cutting blocks on knee models while using these devices was measured.A significant time reduction was demonstration when the Dash Õ device was used: The time reduction was 21% for the tibial block (p ¼ 0.007), 40% for the femoral block (p < 0.001), and 32% for the whole procedure (p < 0.001).The integrated display, fixed on surgical instruments in a manner similar to a spirit level, seems to be more user-friendly for navigation beginners. Hence, unproductive time losses during the learning curve may be diminished.

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“…Patel et al [10] estimated that each day of persistent wound drainage increases the risk of infection by 42%. Although many of the risk factors for persistent wound drainage are also independent risk factors for PJI, including malnutrition [4], excess anticoagulation [6], obesity [12], diabetes [21], and a higher American Society of Anesthesiologists score [12], it is also believed that the path that allows fluid to egress from the wound is a potential conduit for retrograde bacterial Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.…”

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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Wound Complications after Total Knee Arthroplasty

Cited by 91 publications

References 35 publications

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Displays mounted on cutting blocks reduce the learning curve in navigated total knee arthroplasty

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

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