Prolonged wound drainage past two weeks is associated with increased treatment failure following prosthetic joint infection surgery of the hip

PURPOSE: In PJI revision surgery, prolonged wound drainage (PWD) is a common concern associated with increased periprosthetic joint infection (PJI), yet no clinical guidelines exist, guiding when intervention should occur. This study aimed to quantify the association between PWD and treatment failure following hip PJI surgery, and which factors were associated with those results.

METHODS: A retrospective cohort study of hip PJI patients was conducted from March 2019 to January 2023. Univariate and multivariate logistic regression was performed to identify risk factors associated with PWD and failure of treatment (per modified Delphi criteria) Statistical significance was considered for p<0.05.

RESULTS: 164 patients were identified: 98 women (59.8%) and 66 men (40.2%), with a mean age of 69.3±13.9 years, Univariate analysis demonstrated that wound leakage duration was associated with treatment failure (OR:1.1, 95% CI 1.0-1.1, p=0.0024). Multivariate analysis demonstrated that leakage >14 days was the strongest predictor of treatment failure (OR 2.8, 95% CI 1.3-6.0, p=0.0064) Factors associated with leakage >14 days included malnutrition (p=0.0042), number of previous PJI surgeries (p=0.0214), and McPherson host grade 2 (p=0.0230). Gram-negative (p= 0.0266) and polymicrobial hip cultures (p=0.0128) were also associated with prolonged leakage. Univariate associations remained significant with multivariate analysis.

CONCLUSION: Wound drainage >14 days is associated with an elevated risk of failure after PJI surgery. Surgeons should consider early repeat surgery on patients with PWD by two weeks following PJI revision surgery. Previous PJI surgery and malnutrition are risk factors for PWD and should prompt early consultation with nutritional services.