Mylène Jansen

Reduction of pin tract infections during KJD 161 8 The number of patients experiencing infections after frame removal did not differ significantly between groups (6% without Iodosorb® versus 9% with Iodosorb®; p= 0.667). After frame removal, in the group without Iodosorb®, 1 patient received intravenous antibiotics while admitted to the hospital because of suspected osteomyelitis, and the other 1 received 1 7-day course of oral antibiotics for pin tract infection. In the group with Iodosorb®, after frame removal, 1 patient received intravenous antibiotics while admitted to the hospital because of suspected osteomyelitis, a second patient was admitted to the hospital and treated with intravenous antibiotics for a postoperative abscess and a third patient received 1 standard course of oral antibiotics because a pin tract wound was not completely healed. Discussion The most important finding of the present study was that for patients treated with KJD, incorporating the use of cadexomer iodine ointment in the wound care protocol significantly reduces the prevalence of pin tract infections. The number of patients experiencing pin tract infections decreased with 50% by using Iodosorb®. This is a clinically relevant reduction that implicates a significant decrease in treatment burden of patients. An even bigger difference was seen in the number of patients requiring more than a 7-day course of oral antibiotics. The number of patients with these more frequent or serious infections was reduced by 80%. It can be expected that this influences the patient’s general physical and mental health during treatment. The use of cadexomer iodine during KJD treatment did not seem to have an effect on the number of patients experiencing infections after removal of the distraction frame. This may be related to ceasing application of the ointment too early. None of the patients in either group required hospital admission and intravenous antibiotics during treatment. This is a remarkable difference with the previously reported complications experienced in KJD patients treated in regular care, where intravenous antibiotics were necessary for 14% of patients. 9 The fact that in the current study this number was reduced to zero does not seem to be a result of cadexomer iodine use, but may be because of the use of the ArthroSave KneeReviver® frame as compared to the Stryker Dynamic Monotubes used in previous studies, considered by patients to be advantageous with respect to wound care. 15 The number of patients experiencing pin tract infections in this study was based on how many patients required antibiotics. In regular care, when patients have complaints of their pin tract wound and suspect an infection, they consult their physician. If the physician decides that it is an infection, based on the patient’s complaints of pain around the pin tract as well as redness, warmth and pus presence, the patient can start their prescription of antibiotics. As a result, these infections are not confirmed by, for example, positive bacterial cultures. Although it has been shown that swab cultures in pin tract infections are not very helpful 20 , it is possible that