Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are successful orthopaedic procedures with an ever-increasing demand annually worldwide, and persistent wound drainage (PWD) is a well-known complication following these procedures. Despite many definitions for PWD having been proposed, a validated description remains elusive. PWD is a risk factor for periprosthetic joint infection (PJI). PJI is a devastating complication of THA and TKA, and a leading cause of revision surgery with dramatic morbidity and mortality and a significant burden on health socioeconomics. Prevention of PJI has become an essential focus in THA and TKA. Understanding the pathophysiology, risk factors and subsequent management of PWD may aid in decreasing the rate of PJI. Risk factors of PWD can be divided into modifiable and non-modifiable patient risk factors, pharmacological and surgical risk factors. No gold standard treatment protocol to address PWD exists; however, non-operative options progressing to surgical interventions have been described. The aim of this study was to review the current literature regarding PWD and consolidate the risk factors and management strategies available. Cite this article: EFORT Open Rev 2021;6:872-880. DOI: 10.1302/2058-5241.6.200054

Total joint arthroplasty (TJA) is rising globally, with an associated increase in associated complications, necessitating increased efforts in prevention of these complications with pre-operative optimisation. Malnutrition has been highlighted as one of the most important pre-operative modifiable risk factors to be addressed in TJA, with the term malnutrition in orthopaedic surgery having a broad definition that encompasses a wide range of nutritional abnormalities from undernutrition to overnutrition contributing to the outcomes of TJA. Complications associated with malnutrition include periprosthetic joint infection (PJI), periprosthetic fracture, dislocations, aseptic loosening, anaemia, prolonged length of stay (LOS), increased mortality, and raised health care costs. Standardised nutritional scoring tools, anthropometric measurements, and serological markers are all options available in pre-operative nutritional assessment in TJA, but there is no consensus yet regarding the standardisation of what parameters to assess and how to assess them. Abnormal parameters identified using any of the assessment methods results in the diagnosis of malnutrition, and correction of these parameters of overnutrition or undernutrition have shown to improve outcomes in TJA. With the multiple nutritional parameters contributing to the success of total joint arthroplasty, it is imperative that orthopaedic surgeon has a thorough knowledge regarding nutritional peri-operative optimisation in TJA.

Background/Objectives: As the rate of revision total hip arthroplasty (THA) has risen, there has been a drive to improve the technology in the manufacturing of the implants used. One recent advance has been 3-D printing of trabecular titanium implants to improve implant stability and osteointegration. The aim of this study was to review the clinical and radiological outcomes of these acetabular implants in revision THA. Methods: A manual search of the databases of the US National Library of medicine (PubMed/MEDLINE), Embase, and the Cochrane library was performed. The following keywords of “revision total hip arthroplasty” AND “acetabulum” AND “titanium” AND “porous” were utilised. Results: In total, 106 abstracts were identified during manual search of databases. In total, 11 studies reporting 4 different implants, with a total of 597 operated joints in 585 patients were included in this review. There were 349 (59.7%) female patients, and the mean age per study ranged from 56.0 to 78.4 years. The all-cause survival rate was 95.52% (95% CI: 92.37–97.96) at a mean follow up of 3.8 years (95% CI: 2.6–5.1). The 40 cases that required re-operation included 17 (2.8%) for infection, 14 (2.3%) instability, 2 (0.3%) for shell migration and 5 (0.8%) for aseptic loosening. The most commonly used patient reported outcome measure was the Harris Hip Score with the mean post-operative score of 86.7 (95% CI: 84.3–89.1). Conclusions: Trabecular titanium acetabular implants, when used in revision THA, resulted in excellent short- to mid-term outcomes with improved hip specific outcomes and a survivorship of 95.52% over the reported follow-up period. Future prospective studies evaluating long term outcomes are needed to make comparisons between more established solutions used in revision THA.

BACKGROUND: With the global increase in total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA), there has been a parallel increase in complications. Optimising modifiable risk factors preoperatively can limit the impact of postoperative complications. Malnutrition is one such modifiable risk factor. With limited evidence regarding malnutrition in patients undergoing TJA in South Africa, we sought to determine the prevalence of malnutrition in patients presenting for TJA at a single institution in South Africa. The objectives of the study were to determine the prevalence of malnutrition among patients presenting to a South African tertiary institution for TJA, and to determine the relationship between malnutrition and comorbidities and demographics. METHODS: We performed a retrospective review of 414 patients presenting for the first time to an arthroplasty unit over a 15-month period. Patients presenting for primary TJA, revision TJA, and patients presenting for fractured neck of femur (FNF) were included. Serological testing of albumin < 35 g/L and/or low transferrin (< 2 g/L) were used to diagnose malnutrition. The relationship between demographic data, comorbidities, presentation for type of TJA, and malnutrition were evaluated. RESULTS: In total, 414 patients were included. The mean age was 61.1 ± 10.95 years, and 75% (n = 311) were female. Patients presenting for elective TJA composed 88% (n = 366) of the study population, with 12% (n = 48) patients referred for FNF. The mean BMI was 33.3 ± 8.15 kg/m2. The prevalence of malnutrition was 11% (n = 47). Patients presenting for elective TJA had a prevalence of malnutrition of 6% (n = 23), compared to patients presenting with FNF of 50% (n = 24). Hypertension (45%, n = 18), HIV (19%, n = 9), diabetes mellitus (18%, n = 7), chronic kidney disease (18%, n = 7) and inflammatory arthritis (15%, n = 6) were the most common comorbidities in patients with malnutrition. Patients with malnutrition had a higher mean age (p = 0.024), lower mean haemoglobin (p < 0.001), lower mean BMI (p = 0.047) and a lower CD4 in HIV-positive patients (p = 0.031). CONCLUSION: The prevalence of malnutrition of 11% in this cohort of South African patients presenting for TJA is similar to published results from developed countries. There is a need for high-powered prospective studies to determine the viability of routine preoperative nutritional testing or limit testing of high-risk patients. Level of evidence: Level 4

WHAT IS THE COMPLIANCE REGARDING THROMBOPROPHYLAXIS IN POSTOPERATIVE ARTHROPLASTY PATIENTS IN A TERTIARY HOSPITAL IN SOUTH AFRICA?