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Published on: December 3, 2017
Determining the relation between total knee arthroplasty surgery site drainage in two weeks after surgery with
Mehdi Motififard1, Khalilolah Nazem1, Mehdi Meshkati2
1Department of Orthopedic and Trauma, Isfahan University of Medical Science Isfahan, Iran.
Insights
Bloody purulent discharge lasting over seven days after total knee arthroplasty (TKA) may indicate infection. Longer discharge duration and specific discharge types are linked to prosthetic joint infection (PJI) and superficial infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Arthroplasty Research
Background:
- Prosthetic joint infection (PJI) is a severe complication following total knee arthroplasty (TKA).
- Early diagnosis and treatment of PJI are crucial for patient outcomes.
- The relationship between surgical site discharge characteristics and PJI has not been previously studied.
Purpose of the Study:
- To investigate the association between surgical site discharge characteristics (type and duration) and the incidence of PJI after TKA.
- To identify potential risk factors for PJI and superficial infections in TKA patients.
Main Methods:
- A longitudinal observational study involving 961 elective TKAs performed on 850 patients between 2017 and 2019.
- Patients were followed for two years post-surgery to collect data on discharge occurrence, type, duration, and infection rates.
- Data analysis focused on correlating discharge characteristics with the incidence of PJI and superficial infections.
Main Results:
- The incidence rates for superficial infections and PJI were both 0.3%.
- Patients with infections (PJI or superficial) exhibited significantly longer discharge durations (14.6 days for PJI, 13.3 days for superficial infections) compared to the overall study population (7.7 days).
- Bloody-purulent discharge was identified as a significant indicator associated with the development of both PJI and superficial infections.
Conclusions:
- Bloody purulent discharge persisting for seven days or more post-TKA is a strong indicator of potential PJI or superficial infection.
- While discharge characteristics suggest infection, they cannot reliably differentiate between PJI and superficial types.
- Additional risk factors for infection include female gender, longer surgical times, extended hospitalization, and prolonged discharge duration.
Background:
Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) surgeries and prompt diagnosis and treatment are vital; however, no study has been conducted to determine the relationship between characteristics and duration of surgical site discharge and PJI.
Methods:
This is a longitudinal observational study that was performed at Al-Zahra and Kashani and Sadi university hospitals from 2017 until 2019. A total of 961 elective TKA were performed on 850 consecutive patients. Patients were followed up for two years after surgery. Data regarding the occurrence of discharges, types of discharges, duration of discharges, the incidence of PJI and superficial infections were collected.
Results:
The rate of superficial and prosthetic joint infection was 0.3% and 0.3%. Patients with infections (either PJI or superficial) had a longer duration of discharge (14.6 days and 13.3 days in PJI and superficial infections respectively, compared to 7.7 days in all of the study population); Bloody-purulent discharge was associated with the development of prosthetic and superficial infections.
Conclusion:
Bloody purulent discharge reaching seven days postsurgical in TKA patients is highly suggestive of an underlying infection (PJI or superficial infection) but type and duration of discharge could not be used to differentiate between PJI and superficial infection. Other risk factors for PJI or superficial infection include women's gender, longer surgical duration, longer hospitalization and longer discharge duration.
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