Management of persistent postoperative wound leakage after total hip and knee arthroplasty: a regional perspective in the north west of England.

Introduction: There is a well-documented association between persistent wound drainage and the development of prosthetic joint infections in total hip (THA) and total knee arthroplasty (TKA). Despite this, there are no national clinical guidelines in the United Kingdom on the diagnosis or management of postoperative wound drainage. We aimed to evaluate what variability exists within clinical practice in the recognition and treatment of persistent wound leakage following THA and TKA.

Methods: An anonymous online survey consisting of 12 multiple-choice questions was distributed among hip and knee arthroplasty consultants in the north west of England. Topics covered in the questionnaire included definition, diagnosis, classification, timing and treatment of persistent wound drainage.

Results: Twelve orthopaedic centres across the region participated in data collection. A total of 65 consultants completed the questionnaire. Some 45% of respondents used a definition of persistent wound leakage after arthroplasty, which ranged from drainage beyond 48h to that lasting more than 2 weeks. Only 54% of consultants reported having a monitoring system in place for patients with persistent wound drainage after discharge from hospital. There was wide variation in the preferred timing of initiating both non-operative and surgical management of wound leakage, as well as different treatment modalities used. Most respondents rated C-reactive protein as the most useful serological marker in aiding decision making.

Conclusion: The results demonstrate a lack of concurrence in the recognition and management of postoperative wound drainage. Formal national clinical guidelines are necessary to standardise practice.