The defect after removal of the total hip joint replacement

causistic date: 19.07.2013, published: 19. 07. 2013

The defect after removal of the total hip joint replacement University Hospital in Ostrava Orthopaedic Department

An obese female patient, 152/95, born in 1936. THR in 2012

26. 6. 2012 The patient admitted for replantation of a cotyloid cavity due to loosening it. As post-operative complication, the patient developed pulmonary congestion, she was transferred to ICU and the cardiovascular department. During that time, a fistula in a wound occurred with findings of Staphylococcus species, Staphylococcus hominis multiresistant strain. Antibiotic therapy without effect.

3. 8. 2012 Revision of the wound. Recurrence of the defect in the operation wound with abundant secretion and fading of Staphylococcus aureus, coagulase pseudomonas negative. Treated with: Prontosan, Aqacel Ag, Betadine, DeriEcaSan… For repeated loosening of the cotyloid cavity, the patient indicated to removal of the hip joint replacement. Recurrence of the defect in the operation wound. Re-suture of the wound was perfomed. Culture: Klebsiella pneumoniae ESBL, Escheria coli, Enterococcus faecalis, Pseudomonas aeruginosa. Treatment: rinsing with DebriEcaSan, no effect. Occurrence of the new defect in the operation wound. Re-suture performed. Reccurence of the defect. Smear: Staph. Aureus coagulase negative, Pseudomonas aeruginosa. Treatment: rinsing with DebriEcaSan, no effect again.

Foto 1

13.9.2012 Stitches dissolved, the defect ca 3×3 cm, with a fist-size pocket. Heavy cloudy secretion, coated base. Smears: Klebsiella pneumoniae ESBL, Escheria coli, Enterococcus faecalis, Pseudomonas aeruginosa Foto 2

14.9.2012 It was approached to daily re-bandages in combination with rinsing by Prontosan, Traumacel Biodress applied into the wound, using a sterile dressing with content of silver, for five days.

Foto 3 and 4

19. 9. 2012

The wound base clean, with remarkable signs of a granulating tissue, clear secretion, a hole of 2,5×2,5 cm, the pocket size reduced to half. The re-bandages were performed in two days interval, rinsing by Prontosan, Traumacel Biodress applied into the pocket, covered with the sterile dressing with content of silver,

22. 9. 2012 The defect only 2,5×2 cm, the pocket size reduced again to half. Continuous granulation. Treatment: idem

Foto 5 and 6

26. 9. 2012 The defect 2×2×2 cm,, slight secretion, continuing granulation. Treatment: idem. Following regular re-bandages with applying Traumacelem Biodress. The wound base clear, gradually granulating.

Foto 7

16. 10. 2012 Foto 8 and 9

20. 11. 2012 Foto 10 and 11

Conclusion: The application of resorbable Traumacel Biodress straight into the wound pocket „as lining“was something new for us. It relieved the patient from the pain and significantly fastened the healing process. The tissue well responded to the material, and reduction of microbial load enabled to start the healing process Thank to regular care and education of a staff, we enabled the patient after removal of THR to go over to the home care. The patient regularly comes for check-ups and re-bandages. Recommended application of Traumacel Biodress H-gel (on the defect without secretion). The patient was discharged to home care on 26.11.2012

Alena Trojková, In Ostrava, 26.11.2012

Gallery

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