Factors Associated with Prolonged Wound Drainage After Primary Total Hip and Knee Arthroplasty

Patel, Vipul P.; Walsh, Michael; Sehgal, Bantoo; Preston, Charles; DeWal, Hargovind; Di Cesare, Paul E.
January 2007
Journal of Bone & Joint Surgery, American Volume;Jan2007, Vol. 89-A Issue 1, p33
Academic Journal
Background: Prolonged wound drainage following total hip or total knee arthroplasty has been associated with an in- creased risk of postoperative morbidity. The purpose of this study was to determine the pharmacologic, surgical, and patient-specific factors that are associated with prolonged wound drainage and the relationship of this complication to the length of hospital stay and the rate of wound infections. Methods: We conducted a retrospective observational study of 1211 primary total hip arthroplasties and 1226 primary total knee arthroplasties. Prospectively collected data included body mass index, intraoperative blood loss, surgical time, type of prophylaxis against deep venous thrombosis, and length of hospital stay. The association of these factors with the duration of postoperative wound drainage was analyzed. An acute infection developed after fifteen primary total hip arthroplasties and ten primary total knee arthroplasties. The patients with an acute postoperative infection were compared with their uninfected counterparts, and an odds ratio was determined to estimate the risk of prolonged wound drainage resulting in a wound infection. Results: Morbid obesity was strongly associated with prolonged wound drainage in the total hip arthroplasty group (p = 0.001) but not in the total knee arthroplasty group (p = 0.590). An increased volume of drain output was an independent risk factor for prolonged wound drainage in both groups. Patients who received low-molecular-weight heparin for prophylaxis against deep venous thrombosis had a longer time until the postoperative wound was dry than did those treated with aspirin and mechanical foot compression or those who received Coumadin (warfarin); this difference was significant on the fifth postoperative day (p = 0.003) but not by the eighth postoperative day. Prolonged wound drainage resulted in a significantly longer hospital stay in both groups (p < 0.001). Each day of prolonged wound drainage increased the risk of wound infection by 42% following a total hip arthroplasty and by 29% following a total knee arthroplasty. Conclusions: Morbid obesity, the use of low-molecular-weight heparin, and a higher drain output were associated with a prolonged time until the postoperative wound was dry following a primary total hip arthroplasty, whereas a higher drain output was the only risk factor associated with prolonged drainage following a primary total knee arthroplasty. Prolonged drainage was associated with a higher rate of infection following a primary total hip arthroplasty, whereas obesity was the only identified independent risk factor for postoperative infection following a primary total knee arthroplasty.


Related Articles

  • Primary total hip arthroplasty: a comparison of the lateral Hardinge approach to an anterior mini-invasive approach. Wayne, Nathan; Stoewe, Reinhard // Orthopedic Reviews;2009, Vol. 1, p79 

    The anterior mini-invasive (MI) approach to performing total hip arthroplasty (THA) is associated with less soft tissue damage and shorter postoperative recovery than other methods. Our hospital recently abandoned the traditional lateral Hardinge (LH) approach in favour of this new method. We...

  • Independent Nurse: Clinical Focus - Hip and knee replacements. Jeys, Lee // GP: General Practitioner;3/19/2010, p23 

    The article offers information on hip and knee replacement surgery. In 2007-2008, about 150,000 hip and knee replacement operations were performed in Great Britain. Cemented hip replacements have the best long-term survival. Most hip replacements are pain-free after the operation and the most...

  • Effect of Post-Discharge Venous Thromboembolism on Hospital Quality Comparisons Following Hip and Knee Arthroplasty. Kester, Benjamin S.; Merkow, Ryan P.; Ju, Mila H.; Peabody, Terrance D.; Bentrem, David J.; Ko, Clifford Y.; Bilimoria, Karl Y. // Journal of Bone & Joint Surgery, American Volume;9/3/2014, Vol. 96 Issue 17, p1476 

    Background: Symptomatic pre-discharge venous thromboembolism (VTE) rates after total or partial hip or knee arthroplasty have been proposed as patient safety indicators. However, assessing only pre-discharge VTE rates may be suboptimal for quality measurement as the duration of stay is...

  • Obesity Does Not Affect The Accuracy of Acetabular Cup Implantation in Total Hip Replacement. Todkar, Manoj // Internet Journal of Orthopedic Surgery;2007, Vol. 5, p2 

    Post-operative radiographs of 111 patients who had undergone cemented Total Hip Replacement performed or supervised a single surgeon (GCF) were analysed. All surgeries were performed via an anterolateral approach with patients in the lateral position. Patients were stratified according to Body...

  • TOTAL HIP REPLACEMENT. Breusch, Steffen; Alonzi, Carlo // Pulse;6/28/2007, Vol. 67 Issue 25, p38 

    The article discusses post-operative care needed for total hip replacement surgical operations in Great Britain. Upon discharge, both the patient and general practitioner should be given a copy of the discharge summary. Regular medications must be prescribed along with any additional analgesics....

  • What is the optimal time point to assess patient-reported recovery after hip and knee replacement? a systematic review and analysis of routinely reported outcome data from the English patient-reported outcome measures programme. Browne, John Patrick; Bastaki, Hamad; Dawson, Jill // Health & Quality of Life Outcomes;2013, Vol. 11 Issue 1, p1 

    Background: It is unclear if there is a clinically important improvement in the six to 12-month recovery period after hip and knee replacement. This is an obvious gap in the evidence required by patients undergoing these procedures. It is also an issue for the English PROMs (Patient-Reported...

  • Total hip and total knee replacement: postoperative nursing management. Lucas, Brian // British Journal of Nursing;12/11/2008, Vol. 17 Issue 22, p1410 

    Patients having total hip replacement (THR) or total knee replacement (TKR) surgery require skilled nursing care in order to recover from surgery and anaesthesia. The first part of this article will outline the key nursing management issues during the postoperative stage of recovery. The second...

  • Reducing Arthroplasty Costs Via Vendor Contracts. Johnston, D. William C.; Beaupre, Lauren A.; Davies, Donna M.; Hessels, Rick // Canadian Journal of Surgery;Dec99, Vol. 42 Issue 6, p445 

    Describes a method of reducing the costs of implants in hip and knee arthroplasty. What catapulted the restructuring of the health care system in Alberta, Canada; Initiatives attempted to reduce costs; Other cost-cutting initiatives included in the restructuring.

  • cup arthroplasty of hip.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p557 

    An encyclopedia entry for the surgical technique "cup arthroplasty of hip" is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics