(CS-077) Non-operative Management of Surgical Wound Dehiscence Following Knee Fusion: A Multimodality Approach

            The potential morbidity following total knee arthroplasty cannot be understated.  Wound complications can range from simple, superficial erythema to deep wound infection with complete dehiscence and exposure of the surgical hardware.  Periprosthetic joint infections (PJI) have an incidence of 1-2.4% ¹ oftentimes accompanied by complications including skin necrosis, wound dehiscence, and the need for rehospitalization and reoperation.  We present a case of a patient who underwent a total of 11 surgeries to the right knee.  The index surgery was a total knee arthroplasty for end-stage osteoarthritis.  Subsequent surgeries included revisions and washouts for persistent infection with the patient ultimately requiring a knee fusion which subsequently developed a significant wound dehiscence.       

1 Li, T., Zhang, H., Chan, P.K. et al. Risk factors associated with surgical site infections following joint replacement surgery: a narrative review. Arthroplasty 4, 11 (2022). https://doi.org/10.1186/s42836-022-00113-y
 



Methods:

         Utilizing multiple advanced wound healing modalities, our team was able to achieve complete wound closure over the course of three months in the outpatient setting.  These techniques were employed during weekly and biweekly advanced wound clinic visits and included: negative pressure wound therapy (NPWT), serial sharp debridement, enzymatic debridement, chemical cauterization, oral and intravenous antibiotics, multiple animal-based collagen products, non-contact, low-frequency ultrasound, and compression therapy.     

Results:

            The outcome of complete wound closure was truly life-altering for this patient as they were advised that an above the knee amputation would be the necessary alternative if we were unable to achieve wound closure.  For perspective, the largest wound dimensions were 17.0cm x 4.0cm x 1.5cm.

Discussion:

         It is generally accepted that operative management is required for periprosthetic knee infections with associated wound dehiscence.² We present a potential, non-operative alternative in the carefully selected patient under close observation with frequent follow up in an advanced wound clinic. 
2 Garbedian S, Sternheim A, Backstein D. Wound healing problems in total knee arthroplasty. Orthopedics. 2011 Sep 9;34(9):e516-8. doi: 10.3928/01477447-20110714-42. PMID: 21902149.