Wound problems and infections after major joint arthroplasty

Abstract

Aims Early postoperative wound problems following major joint arthroplasty (MJA) are common, yet comprehensive guidelines for superficial surgical site infections (SSIs) are lacking. This study aimed to explore healthcare professionals’ views and management strategies for early wound problems after MJA. Methods A national cross-sectional online survey was distributed to orthopaedic surgeons, microbiologists, general practitioners, physiotherapists, and nursing staff involved in MJA care. The survey explored perceptions of wound problems, along with diagnostic and management approaches, and sought to identify any evidence gaps. Results were reported with descriptive statistics. Results Of 111 respondents (51% orthopaedic surgeons), 90% were involved in managing early MJA wound problems. Most (94.6%) considered early wound problems serious. Skin reactions (32.4%) and superficial wound infections (28.8%) were the most frequently cited causes. Respondents generally believed superficial infections could not be clinically distinguished from deep infections, but could be managed with oral antibiotics in primary care. However, a need for further evidence was expressed, particularly regarding diagnostic utility, intervention thresholds, and clear guidelines to differentiate superficial from deep infections. Common superficial infection signs included red skin and localized swelling, while deep infections were thought to present with fever and deep pain. Conclusion Healthcare professionals recognize the seriousness of early postoperative wound problems, frequently encountering skin reactions and superficial SSIs. While superficial infections are often managed nonoperatively, there is a clear demand for high-level evidence and comprehensive guidelines to improve differentiation and management. This should ultimately enhance patient outcomes, reduce the time to correct diagnosis and management, and limit the need for unnecessary treatments and associated complications. Cite this article: Bone Jt Open 2026;7(10):1384–1391.