What are the treatments for post-operative knee replacement dressing (bandage) reaction?

From the Guidelines

For a bandage reaction after knee replacement surgery, I strongly recommend opening the incision and evacuating the infected material, followed by dressing changes until the wound heals by secondary intention, as this approach has been shown to be the most effective therapy for surgical site infections (SSIs) 1. When it comes to managing a bandage reaction after knee replacement surgery, it's essential to prioritize the patient's morbidity, mortality, and quality of life.

• The first step is to assess the severity of the reaction, looking for signs of infection such as purulent incisional drainage, positive culture of aseptically obtained fluid or tissue from the superficial wound, local signs and symptoms of pain or tenderness, swelling, and erythema after the incision is opened by the surgeon 1.
• If the reaction is mild, with less than 5 cm of erythema and induration, and minimal systemic signs of infection, antibiotics may be unnecessary 1.
• However, if the patient has a temperature greater than 38.5°C, heart rate greater than 110 beats per minute, or erythema extending beyond the wound margins for more than 5 cm, a short course of antibiotics (24-48 hours) may be required, in addition to opening the suture line 1.
• The choice of antibiotic should be empiric, but can be supported by Gram stain, culture of the wound contents, and the site of surgery 1.
• It's also crucial to keep the area clean and dry, washing gently with mild soap and water, and to inform the healthcare provider about the reaction so they can document the patient's adhesive sensitivity for future procedures.
• Severe symptoms such as spreading redness, significant swelling, increasing pain, fever, or pus drainage should prompt immediate contact with the surgeon, as these could indicate infection rather than a simple bandage reaction.

From the Research

Medicines for Post-Op Knee Replacement Bandage Reaction

• There are various studies that have investigated the use of medicines to reduce inflammation and pain after knee replacement surgery, which can help with bandage reaction.
• A study published in 2021 2 found that peri-operative steroid supplementation can reduce pain, inflammatory response, and hospitalization length after knee arthroplasty without increasing the risk of acute complications.
• Another study published in 2020 3 found that intra-articular corticosteroid injections after total knee arthroplasty can increase the risk of periprosthetic infection.
• A study published in 2017 4 found that surgery-induced inflammation, particularly increased IL-10 response, was associated with decreased long-term functional performance after total knee arthroplasty.
• A study published in 2022 5 identified biological risk factors for persistent postoperative pain after total knee arthroplasty, including cytokine levels in plasma and synovial fluid.

Inflammation and Pain Management

• The use of compression bandages has been shown to reduce bleeding and swelling after knee replacement surgery, which can help with bandage reaction 6.
• Steroid supplementation has been found to reduce pain, inflammatory response, and hospitalization length after knee arthroplasty 2.
• Cytokine levels, such as IL-10, IL-1β, and IL-12/IL-23p40, have been found to be associated with persistent postoperative pain after total knee arthroplasty 5.

Complications and Risks

• Intra-articular corticosteroid injections after total knee arthroplasty can increase the risk of periprosthetic infection 3.
• The use of steroid supplementation should be carefully considered, as it can have potential risks and complications, such as increased blood glucose levels 2.