What should be done for patients with persistent wound drainage (PWD) after total joint arthroplasty? What are the indications for surgical intervention?

Authors: Ali Oliashirazi, James J. Purtill, Brianna Fram
RECOMMENDATION: Management of draining wounds after total hip arthroplasty (THA) or total knee arthroplasty (TKA) consists of two main steps; nonoperative and operative. The nonoperative measures include: modifi cation of venous thromboembolism (VTE) prophylaxis, nutritional supplementation, dressing measures (such as negative pressure wound therapy (NPWT)) and restriction of range of motion. If draining continues for more than seven days after implementing the nonoperative measures, operative interventions may be indicated – including irrigation and debridement, synovectomy and single-stage exchange. In certain situations, superfi cial wound washout may be indicated (Fig. 1).
LEVEL OF EVIDENCE: Limited
DELEGATE VOTE: Agree: 89%, Disagree: 8%, Abstain: 3% (Super Majority, Strong Consensus)

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