Case Report

Wound Dehiscence, a Potential Complication of Total Knee Arthroplasty in a COVID-19 Patient: A Case Report and Literature Review

Abstract

Background: Dehiscence of the wound is an infrequent complication following total knee arthroplasty (TKA); numerous risk factors are responsible for this. This study aims to represent a case who underwent TKA, was infected with coronavirus disease-2019 (COVID-19) soon afterward, took corticosteroid as an immunosuppressive agent to resolve COVID-19 symptoms, and presented with wound dehiscence with minor trauma in early postoperative follow-ups.

 

Case Report: A 62-year-old man underwent TKA, and soon after discharge from the hospital, he was hospitalized with COVID-19. A corticosteroid was started for the patient, and a traumatic impaction occurred on his operated knee after he fell in the hospital. As a result, wound dehiscence was performed on the operated knee.

 

Conclusion: Numerous risk factors such as diabetes mellitus and corticosteroid consumption are implicated as known risk factors for wound dehiscence after TKA, which must be followed precisely to prevent the unfortunate development of such complications. Postoperative care must be considered in patients at risk for wound dehiscence. In the presented case, wound management was fulfilled with proper timing of irrigation and debridement without any prosthesis component exchange.

 

1. Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, et al. Predictors of wound infection in hip and knee joint replacement: Results from a 20-year surveillance program. J Orthop Res. 2002;20(3):506-15. doi: 10.1016/S0736-0266(01)00153-X. [PubMed:12038624].

2. Simons MJ, Amin NH, Scuderi GR. Acute wound complications after total knee arthroplasty: Prevention and management. J Am Acad Orthop Surg. 2017;25(8):547-55. doi: 10.5435/JAAOS-D- 15-00402. [PubMed: 28737615].

3. Bozic KJ, Lau E, Kurtz S, Ong K, Rubash H, Vail TP, et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am. 2012;94(9):794-800. doi: 10.2106/JBJS.K.00072. [PubMed: 22552668].

4. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4): 780-5. doi: 10.2106/JBJS.F.00222. [PubMed: 17403800].

5. Dennis DA. Wound complications in total knee arthroplasty. In: Sculco TP, Martucci EA, editors. Knee Arthroplasty. Vienna, Austria: Springer Vienna; 2001. p. 163-9.

6. Wang AS, Armstrong EJ, Armstrong AW. Corticosteroids and wound healing: clinical considerations in the perioperative

period. Am J Surg. 2013;206(3):410-7. doi:

10.1016/j.amjsurg.2012.11.018. [PubMed: 23759697].

7. van PJ, Vos JS, Hoekstra EM, Neumann KMI, Boot PC, Arbous SM. Corticosteroid use in COVID-19 patients: A systematic review and meta-analysis on clinical outcomes. Crit Care. 2020;24(1):696. doi: 10.1186/s13054-020-03400-9. [PubMed: 33317589]. [PubMed Central: PMC7735177].

8. Mortazavi SJ, Kalantar SH, Moharrami A, Zarei M, Hosseini zare

N. Total joint arthroplasty during coronavirus disease-2019 COVID-19 pandemic. J Orthop Spine Trauma. 2021;6(2):28-9. doi: 10.18502/jost.v6i2.4783.

9. Sheikhbahaei E, Mirghaderi SP, Moharrami A, Habibi D, Motififard M, Mortazavi SMJ. Incidence of symptomatic COVID-19 in unvaccinated patients within one month after elective total joint arthroplasty: A multicenter study. Arthroplast Today. 2022;14:110-5. doi: 10.1016/j.artd.2022.01.024. [PubMed: 35097167]. [PubMed Central: PMC8784429].

10. Ackerman DB, Trousdale RT, Bieber P, Henely J, Pagnano MW, Berry DJ. Postoperative patient falls on an orthopedic inpatient unit. J Arthroplasty. 2010;25(1):10-4. doi: 10.1016/j.arth.2008.09.025. [PubMed: 19062249].

11. Gausden EB, Shirley MB, Abdel MP, Sierra RJ. Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty. Bone Joint J. 2021;103-B(6 Supple A):191-5. doi: 10.1302/0301-620X.103B6.BJJ-2020-2425.R1. [PubMed: 34053286].

12. Adam RF, Watson SB, Jarratt JW, Noble J, Watson JS. Outcome after flap cover for exposed total knee arthroplasties. A report of 25 cases. J Bone Joint Surg Br. 1994;76(5):750-3. [PubMed: 8083264].

13. Inabathula A, Dilley JE, Ziemba-Davis M, Warth LC, Azzam KA, Ireland PH, et al. Extended oral antibiotic prophylaxis in high-risk patients substantially reduces primary total hip and knee arthroplasty 90-day infection rate. J Bone Joint Surg Am. 2018;100(24):2103-9. doi: 10.2106/JBJS.17.01485. [PubMed: 30562290].

14. Sershon RA, Tecle N, Della Valle CJ, Levine BR, Berger RA, Nam

D. The impact of an acute, traumatic wound dehiscence on clinical outcomes following primary knee arthroplasty. J Arthroplasty. 2018;33(8):2613-5. doi: 10.1016/j.arth.2018.02.090. [PubMed: 29636248].

15. Vince K, Chivas D, Droll KP. Wound complications after total knee arthroplasty. J Arthroplasty. 2007;22(4 Suppl 1):39-44. doi: 10.1016/j.arth.2007.03.014. [PubMed: 17570276].

16. Partezani HC, Sobrado MF, Cotegipe Negrelli MA, Pecora JR, Gomes GR, Angelini FJ. High potential for complications after traumatic exposure in patients with a total knee replacement. Wounds. 2020;32(5):142-5. [PubMed: 32804666].

17. Laing JH, Hancock K, Harrison DH. The exposed total knee replacement prosthesis: A new classification and treatment algorithm. Br J Plast Surg. 1992;45(1):66-9. doi: 10.1016/0007-1226(92)90120-m. [PubMed: 1737214].
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IssueVol 9, No 2 (2023) QRcode
SectionCase Report
DOI https://doi.org/10.18502/jost.v9i2.12630
Keywords
COVID-19 Knee Arthroplasty Surgical Wound Dehiscence
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How to Cite
1.
Mafi AH, Toofan H, Moharrami A, Salehi M, Ayati Firoozabadi M. Wound Dehiscence, a Potential Complication of Total Knee Arthroplasty in a COVID-19 Patient: A Case Report and Literature Review. J Orthop Spine Trauma. 2023;9(2):93-5.