Skip to main content

Advertisement

Log in

Factors associated with prolonged wound drainage after hemiarthroplasty for hip fractures in elderly

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the incidence of prolonged wound drainage (PWD) and the amount of drainage fluid after hip hemiarthroplasty (HA) and to investigate the risk factors for the development of PWD associated with the patient, fracture and surgical treatment.

Methods

Data from 313 patients who underwent HA were prospectively analysed. The mean drainage time and drainage amount of patients with PWD were calculated. Patient demographic data, pre-operative ASA scores and anticoagulation status, presence of diabetes, fracture type, surgical approach, femoral stem type, cable usage, amount of drain output, blood transfusion quantity, time from injury to surgery, time from surgery to discharge and patient blood tests were investigated.

Results

The incidence of PWD after HA was 8.9% (28 patients). The mean drainage time in patients with PWD was 4.9 ± 1.85 (3–9) days, and the mean collected total fluid volume was 51.1 ± 26.9 (21–132) mL. PWD was more commonly observed in the lateral approach group (p < 0.001) and morbidly obese patients (p < 0.001). In the PWD group, the mean post-operative first-day haemoglobin value was lower (p < 0.001), more blood transfusions were required (p < 0.001) and the amount of drainage output from the closed suction drain (CSD) was higher (p < 0.001). The duration of hospitalization was longer in patients with PWD (p < 0.001). Lateral approach, morbid obesity and increased drainage output were found to be associated with PWD in logistic regression analysis.

Conclusion

Lateral approach, morbid obesity and increased drainage output were found to be risk factors for the occurrence of PWD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Cordero-Ampuero J, de Dios M (2010) What are the risk factors for infection in hemiarthroplasties and total hip arthroplasties? Clin Orthop Relat Res 468:3268–3277. https://doi.org/10.1007/s11999-010-1411-8

    Article  PubMed  PubMed Central  Google Scholar 

  2. Florschutz AV, Fagan RP, Matar WY, Sawyer RG, Berrios-Torres SI (2015) Surgical site infection risk factors and risk stratification. J Am Acad Orthop Surg 23(Suppl):S8–s11. https://doi.org/10.5435/jaaos-d-14-00447

    Article  PubMed  PubMed Central  Google Scholar 

  3. Noailles T, Brulefert K, Chalopin A, Longis PM, Gouin F (2016) What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. Int Orthop 40:1843–1848. https://doi.org/10.1007/s00264-015-3033-y

    Article  PubMed  Google Scholar 

  4. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715. https://doi.org/10.1007/s11999-008-0209-4

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wagenaar FBM, Lowik CAM, Zahar A, Jutte PC, Gehrke T, Parvizi J (2019) Persistent wound drainage after total joint arthroplasty: a narrative review. J Arthroplasty 34:175–182. https://doi.org/10.1016/j.arth.2018.08.034

    Article  PubMed  Google Scholar 

  6. CAM L, Wagenaar FC, van der Weegen W, Poolman RW, Nelissen R, Bulstra SK, Pronk Y, Vermeulen KM, Wouthuyzen-Bakker M, van den Akker-Scheek I, Stevens M, Jutte PC, group Ls (2017) LEAK study: design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty. BMJ Open 7:e018673. https://doi.org/10.1136/bmjopen-2017-018673

    Article  Google Scholar 

  7. Ghanem E, Heppert V, Spangehl M, Abraham J, Azzam K, Barnes L, Burgo FJ, Ebeid W, Goyal N, Guerra E, Hitt K, Kallel S, Klein G, Kosashvili Y, Levine B, Matsen L, Morris MJ, Purtill JJ, Ranawat C, Sharkey PF, Sierra R, Stefansdottir A (2014) Wound management. J Orthop Res 32(Suppl 1):S108–S119. https://doi.org/10.1002/jor.22554

    Article  PubMed  Google Scholar 

  8. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J (2012) Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 27:61-65.e61. doi:https://doi.org/10.1016/j.arth.2012.02.022

  9. Al-Houraibi RK, Aalirezaie A, Adib F, Anoushiravani A, Bhashyam A, Binlaksar R, Blevins K, Bonanzinga T, Chih-Kuo F, Cordova M, Deirmengian GK, Fillingham Y, Frenkel T, Gomez J, Gundtoft P, Harris MA, Harris M, Heller S, Jennings JA, Jiménez-Garrido C, Karam JA, Khlopas A, Klement MR, Komnos G, Krebs V, Lachiewicz P, Miller AO, Mont MA, Montañez E, Romero CA, Schwarzkopf R, Shaffer A, Sharkey PF, Smith BM, Sodhi N, Thienpont E, Villanueva AO, Yazdi H (2019) General assembly, prevention, wound management: proceedings of international consensus on orthopedic infections. J Arthroplasty 34:S157–s168. https://doi.org/10.1016/j.arth.2018.09.066

    Article  PubMed  Google Scholar 

  10. Ng VY, Lustenberger D, Hoang K, Urchek R, Beal M, Calhoun JH, Glassman AH (2013) Preoperative risk stratification and risk reduction for total joint reconstruction: AAOS exhibit selection. J Bone Joint Surg Am 95:e191–e115. https://doi.org/10.2106/jbjs.l.00603

    Article  PubMed  Google Scholar 

  11. Parvizi J, Gehrke T, Chen A (2013) Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J 95:1450–1452. https://doi.org/10.1302/0301-620X.95B11.33135

    Article  PubMed  Google Scholar 

  12. Adelani M, Johnson S, Keeney J, Nunley R, Barrack R (2014) Clinical outcomes following re-admission for non-infectious wound complications after primary total knee replacement. Bone Joint J 96:619–621. https://doi.org/10.1302/0301-620X.96B5.33479

    Article  PubMed  Google Scholar 

  13. Jaberi FM, Parvizi J, Haytmanek CT, Joshi A, Purtill J (2008) Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res 466:1368–1371. https://doi.org/10.1007/s11999-008-0214-7

    Article  PubMed  PubMed Central  Google Scholar 

  14. Patel VP, Walsh M, Sehgal B, Preston C, DeWal H, Di Cesare PE (2007) Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am 89:33–38. https://doi.org/10.2106/JBJS.F.00163

    Article  PubMed  Google Scholar 

  15. Maathuis P, de Hartog B, Bulstra S (2009) Timing of open debridement for suspected infection of joint prosthesis: a report on 551 patients. Curr Orthop Pract 20:541–545. https://doi.org/10.1097/BCO.0b013e3181a0a7fb

    Article  Google Scholar 

  16. Aggarwal VK, Elbuluk A, Dundon J, Herrero C, Hernandez C, Vigdorchik JM, Schwarzkopf R, Iorio R, Long WJ (2019) Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J 101-b:646-651. doi:https://doi.org/10.1302/0301-620x.101b6.bjj-2018-1474.r1

  17. van der Sijp MPL, van Delft D, Krijnen P, Niggebrugge AHP, Schipper IB (2018) Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: a meta-analysis. J Arthroplasty 33:1617-1627.e1619. doi:https://doi.org/10.1016/j.arth.2017.12.029

  18. Biber R, Brem M, Singler K, Moellers M, Sieber C, Bail HJ (2012) Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases. Int Orthop 36:2219–2223. https://doi.org/10.1007/s00264-012-1624-4

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ahmed AA, Mooar PA, Kleiner M, Torg JS, Miyamoto CT (2011) Hypertensive patients show delayed wound healing following total hip arthroplasty. PLoS One 6:e23224. https://doi.org/10.1371/journal.pone.0023224

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Kilpadi DV, Cunningham MR (2011) Evaluation of closed incision management with negative pressure wound therapy (CIM): hematoma/seroma and involvement of the lymphatic system. Wound Repair Regen 19:588–596. https://doi.org/10.1111/j.1524-475X.2011.00714.x

    Article  PubMed  Google Scholar 

  21. Pauser J, Nordmeyer M, Biber R, Jantsch J, Kopschina C, Bail HJ, Brem MH (2016) Incisional negative pressure wound therapy after hemiarthroplasty for femoral neck fractures - reduction of wound complications. Int Wound J 13:663–667. https://doi.org/10.1111/iwj.12344

    Article  PubMed  Google Scholar 

  22. Strahovnik A, Fokter SK, Kotnik M (2010) Comparison of drainage techniques on prolonged serous drainage after total hip arthroplasty. J Arthroplasty 25:244–248. https://doi.org/10.1016/j.arth.2008.08.014

    Article  PubMed  Google Scholar 

  23. Abdel MP, Barreira P, Battenberg A, Berry DJ, Blevins K, Font-Vizcarra L, Frommelt L, Goswami K, Greiner J, Janz V, Kendoff DO, Limberg AK, Manrique J, Moretti B, Murylev V, O'Byrne J, Petrie MJ, Porteous A, Saleri S, Sandiford NA, Sharma V, Shubnyakov I, Sporer S, Squire MW, Stockley I, Tibbo ME, Turgeon T, Varshneya A, Wellman S, Zahar A (2019) Hip and knee section, treatment, two-stage exchange spacer-related: proceedings of international consensus on orthopedic infections. J Arthroplasty 34:S427–s438. https://doi.org/10.1016/j.arth.2018.09.027

    Article  PubMed  Google Scholar 

  24. Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA (2016) Periprosthetic joint infection. Lancet 387:386–394. https://doi.org/10.1016/S0140-6736(14)61798-0

    Article  PubMed  Google Scholar 

  25. Toma O, Suntrup P, Stefanescu A, London A, Mutch M, Kharasch E (2011) Pharmacokinetics and tissue penetration of cefoxitin in obesity: implications for risk of surgical site infection. Anesth Analg 113:730–737. https://doi.org/10.1213/ANE.0b013e31821fff74

    Article  PubMed  CAS  Google Scholar 

  26. D’Apuzzo MR, Novicoff WM, Browne JA (2015) The John Insall award: morbid obesity independently impacts complications, mortality, and resource use after TKA. Clin Orthop Relat Res 473:57–63. https://doi.org/10.1007/s11999-014-3668-9

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Umut Canbek.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Canbek, U., Akgun, U., Aydogan, N.H. et al. Factors associated with prolonged wound drainage after hemiarthroplasty for hip fractures in elderly. International Orthopaedics (SICOT) 44, 1823–1831 (2020). https://doi.org/10.1007/s00264-020-04738-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04738-z

Keywords

Navigation