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Reduced wound leakage in arthroplasty with modified wound closure: a retrospective cohort study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Wound leakage has been shown to increase the risk of prosthetic joint infections (PJIs) in primary total hip (THA) and knee arthroplasty (unicondylar and total knee arthroplasty; KA). The aim of this study is to determine whether the addition of a continuous subcuticular bonding stitch to a conventional three-layer closure method reduces the incidence of prolonged wound leakage and PJIs after THA and KA.

Materials and methods

This retrospective cohort study included all patients receiving a THA or KA. Patients in the control group with a three-layer closure method had surgery between November 1st 2015 and October 31st 2016, and were compared to the study group with a four-layer closure method that had surgery between January 1st 2017 and December 31st 2018. The primary outcome was incidence of prolonged wound leakage longer than 72 h. Differences were evaluated using logistic regression. Incidence of PJIs was the secondary outcome.

Results

A total of 439 THA and 339 KA in the control group and 460 THA and 350 KA in the study group were included. In the control group, 11.7% of the patients had a prolonged leaking wound compared to 1.9% in the study group (p < 0.001). The modified wound closure method showed a protective effect for obtaining prolonged wound leakage; odds ratios were 0.09 (95% CI 0.04–0.22; p < 0.001) for THA and 0.21 (95% CI 0.10–0.43; p < 0.001) for KA. PJIs decreased from 1.54 to 0.37% (p = 0.019).

Conclusions

The addition of a continuous subcuticular bonding stitch reduces the incidence of prolonged wound leakage and PJIs after THA and KA compared to a conventional three-layer wound closure method. The large reduction of incidence in wound leakage and PJIs in this study, combined with relatively negligible cost and effort of the modified wound closure method, would advocate for implementing this wound closure method in arthroplasty.

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Acknowledgements

We would like to thank Rebecca McIntyre for reviewing this article as native speaker. We would like to thank Joost Guttinger for designing Fig. 2. And we would like to thank all orthopaedic surgeons of our department, N. Verschoor, D. A. Dartee, C. M. Douw, H. K. M. Hamelinck, D. J. van Doeselaar, D. van Oostveen, H. J. T. A. M. Huijbregts and N. Bennink for making this study possible.

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Authors and Affiliations

  1. Department of Orthopaedics, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, Hertogenbosch, The Netherlands

    R. L. Roerdink, A. W. Plat, R. P. van Hove & B. C. van der Zwaard

  2. Department of Microbiology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, Hertogenbosch, The Netherlands

    A. C. A. P. Leenders

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  1. R. L. Roerdink
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Correspondence to R. L. Roerdink.

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Roerdink, R.L., Plat, A.W., van Hove, R.P. et al. Reduced wound leakage in arthroplasty with modified wound closure: a retrospective cohort study. Arch Orthop Trauma Surg 139, 1505–1510 (2019). https://doi.org/10.1007/s00402-019-03178-8

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