THE PROBLEM WOUND: A KNEE IS NOT A HIP

Obtaining primary wound healing in total joint arthroplasty (TJA) is essential to a good result. Wound healing disturbances (WHD) can occur and the consequences can be devastating to the patient and to the surgeon. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as Type A: no healing compromises and Type B: systemic or local healing compromise factors present. Local factors include traumatic arthritis with multiple previous incisions, extensive scarring, lymphodema, poor vascular perfusion, and excessive local adipose deposition. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. Low serum albumin, total lymphocyte count, and low transferrin increase WHD. In high risk situations the surgeon should encourage positive patient choices such as smoking cessation and nutritional supplementation to modify healing responses. Use of tourniquet...