PRACTICE PEARLS: Insights on Managing the Wound after TJA

    Four leading orthopaedic surgeons address issues with surgical incisions, persistent wound drainage, and deep periprosthetic infection in presentations from ICJR meetings.

    Surgical Incision Management
    Giles R. Scuderi, MD

    Dr. Giles Scuderi believes wound complications following joint replacement surgery are under-reported because they are typically considered to be “minor” complications.

    But this minor complication can become a serious issue: A wound complication can lead to a surgical site infection, which can result in significant morbidity and cost.

    In this presentation, Dr. Scuderi reviews strategies for minimizing wound complications, including exposure and soft tissue handling, wound closure, and choice of postoperative dressing. 

    Click the image above to watch Dr. Scuderi’s presentation.

    Persistent Wound Drainage
    John W. Barrington, MD

    Prolonged wound drainage after total joint arthroplasty is associated with an up to 12.5 times higher risk for developing deep infection, says Dr. John Barrington.

    So it makes sense that with regard to wound drainage, “An ounce of prevention is better than a pound of cure,” to quote Benjamin Franklin.

    In this presentation, Dr. Barrington reviews his multimodal approach for minimizing tissue trauma to prevent persistent wound drainage, which includes addressing preoperative/systemic factors, operative/surgical factors, and postoperative/dressing factors.

    Click the image above to watch Dr. Barrington’s presentation.

    The Management of Wound Problems After TJA
    Bryan D. Springer, MD

    Wound complications are the number 1 reason for readmissions after total joint arthroplasty, says Dr. Bryan Springer, and research has demonstrated the consequences of these complications: They have been found to be a harbinger for surgical site infections and deep periprosthetic infections.

    In this presentation, Dr. Springer addresses how to manage prior incisions, how to optimize the wound through good wound closure technique and appropriate dressing choice, and how to deal with a problematic wound after surgery, particularly with regard to persistent wound drainage. 

    Click the image above to watch Dr. Springer’s presentation.

    Incision Management: Tips for Preventing PJI
    H. John Cooper, MD

    Dr. John Cooper notes that a Mayo Clinic study reported a significantly increased risk for periprosthetic joint injection in total knee arthroplasty patients who had required early surgical treatment for a wound healing problem.

    This finding demonstrates the importance of obtaining primary wound healing to avoid wound complications, he says.

    In his presentation, Dr. Cooper reviews strategies for minimizing wound complications, as well as strategies for reducing the risk of infection if these wound complications develop.

    Click the image above to watch Dr. Cooper’s presentation.