Publication:

Does geography influence wound healing following revision total hip arthroplasty for periprosthetic joint infection? A retrospective comparative cohort study

Background Periprosthetic joint infection (PJI) after revision total hip arthroplasty (THA) poses significant wound-management challenges. Outcomes following vacuum-assisted closure (VAC) therapy vary and may be influenced by regional microbiology and host soft-tissue characteristics.

Methods This retrospective comparative cohort study (2019-2025) included adults undergoing revision THA for chronic PJI at a tertiary center. Patients were grouped by geographic origin: India (n=20) and Democratic Republic of Congo (DRC; n=18). Demographics, microbiology, postoperative wound gaping, debridement and VAC sessions, soft-tissue reconstruction, and time to complete wound healing were analysed using non-parametric statistics.

Results The Indian cohort was younger (60.3 vs 67.8 years; p=0.010) but required more debridement’s (3.1 vs 2.3; p=0.031), VAC sessions (2.7 vs 1.6; p=0.003), and flap reconstructions (70% vs 22%). Initial wound gaping occurred at a similar postoperative interval in both cohorts; however, healing time was significantly longer in Indian patients (36.8 vs 18.2 days; p=0.002). Klebsiella predominated in the Indian cohort, whereas Pseudomonas was more common in DRC patients.

Conclusions Geographic differences in wound behaviour following revision THA for PJI suggest that regional microbiology and host soft-tissue factors influence VAC effectiveness and healing outcomes, supporting population-specific wound management strategies.