Addressing Wound Closure in Total Joint Arthroplasty

    Wound management is an often-neglected area of orthopaedic surgery. In fact, says Ryan M. Nunley, MD, there is a common belief that wound drainage and blistering are relatively rare occurrences, and as a result, surgeons don’t typically spend a lot of time discussing how wound closure and surgical dressings affect wound healing and the development of periprosthetic joint infection (PJI).

    But it is an issue worth much discussion, as the wound is a reflection of what is happening beneath the skin, Dr. Nunley said in a presentation on wound management at ICJR’s annual Winter Hip & Knee Course.

    A combination of systemic and surgical factors can put the patient at risk for a PJI, including diabetes, rheumatoid arthritis, steroid use, wound drainage, wound hematoma, and wound dehiscence – the last 3 related to the surgical technique. Dr. Nunley says that the surgical tenets developed by legendary surgeon William S. Halstead, MD, in the late 19th century are just as applicable to surgical wound management today:

    • Sharp surgical dissection
    • Gentle handing of tissue
    • Careful hemostasis
    • Obliteration of dead space
    • Avoidance of tension on closure

    During his presentation, Dr. Nunley discussed the goals of wound management and the types of wound closure, and then he showed a surgical technique video to demonstrate how he uses barbed suture to close the arthrotomy in a total knee arthroplasty.

    Click the image above to watch Dr. Nunley’s presentation.


    Dr. Nunley has disclosed that he is a paid consultant for Biocomposites, Blue Belt Technology, Cardinal Health, DePuy Sythes, Ethicon, Medtronic, MicroPort Orthopedics, and Smith & Nephew.