Time-dependent wound management protocol prevents periprosthetic joint infection in total knee arthroplasty with persistent drainage.

Abstract

Purpose: This study aimed to evaluate the success rate of a standardised protocol for managing persistent wound drainage following total knee arthroplasty (TKA).

Methods: A prospective observational study was conducted at four institutions between January and June 2022 across primary and revision TKAs. Sixty-two patients (mean age 71.5 ± 9.3 years; 45.2% male) who experienced postoperative wound drainage after primary (58.1%) or revision (41.9%) TKA were enrolled. The protocol included staged interventions: anticoagulation adjustments and dressing changes during Days 1-3, incisional negative pressure wound therapy during Days 3-5, and wound debridement above the joint capsule if drainage persisted beyond Day 7. Outcomes were evaluated using the ASEPSIS score. The primary outcome was defined as complete wound healing without progression to debridement, antibiotics and implant retention (DAIR) procedure or periprosthetic joint infection (PJI).

Results: The mean follow-up was 13.2 months (range, 11.7-15.1 months). The protocol achieved a 91.9% success rate in preventing progression to DAIR. The median number of visits required to achieve wound healing was 3.5 for the cohort. DAIR rate was 8.1% (n = 5), while PJI rate was 1.6% (n = 1). Primary TKA procedures demonstrated more efficient healing trajectories compared to revision cases, requiring fewer clinical visits (median 3 vs. 5, p < 0.001) and shorter hospital stays (mean 4.5 vs. 7.5 days, p = 0.017). Cox proportional hazards model identified intervention type (revision vs. primary, hazard ratio [HR] 0.24, p < 0.001), advanced age (HR: 0.95 per year, p = 0.006), and male gender (HR: 0.45, p = 0.020) as significant independent predictors of increased time required to achieve wound healing.

Conclusion: Our standardised wound management protocol achieved a high success rate in preventing progression to PJI following TKA. The time-dependent approach to intervention escalation provides clear clinical decision-making criteria and suggests that early identification and systematic management of wound complications are critical determinants of successful outcomes, particularly for primary TKA procedures.

Level of evidence: Level II.