Negative Pressure Incisional Therapy and Infection After Direct Anterior Approach Primary Total Hip Arthroplasty

Abstract

With the aging of the US population, total hip arthroplasty (THA) is becoming an increasingly common procedure. A major concern after THA is reducing infection rates, as infections can cause devastating complications. Improved sterile technique, standardized infection control protocols, and novel dressings have been used to reduce postoperative surgical site infections (SSIs). The use of either silver-impregnated dry dressings or easily applied incisional negative pressure dressings is aimed at reducing the rates of SSIs after primary anterior THA. The authors retrospectively reviewed the medical records of 275 patients who underwent anterior THA at their institution during a 1-year period. Patients were separated into groups based on their surgical dressing. Rates of SSI were documented, and the effects of various factors, including age, sex, body mass index, and comorbidities, were compared between the 2 cohorts. The authors also analyzed high-risk patients to determine whether easily applied incisional negative pressure dressings reduced infections. The use of easily applied incisional negative pressure dressings after primary anterior THA did not have a statistically significant impact on SSI rate ( P =.42). There was also no difference in SSI, readmission, or reoperation in the high-risk group. The goal of using an incisional negative pressure wound therapy device is to help further decrease the risk of SSI. This study's findings suggest that the SSI rate in this group did not differ from that in the standard dressing group, such that the prophylactic use of a negative pressure wound therapy device is not indicated for either standard or high-risk patients undergoing primary anterior approach THA. [ Orthopedics . 2019; 42(6):e539–e544.]

The Utility of Perioperative Products for the Prevention of Surgical Site Infections in Total Knee Arthroplasty and Lower Extremity Arthroplasty: A Systematic Review

“…Among the 14 studies that evaluated the PREVENA therapy NPWT system, 10 reported decreased rates of SSIs compared with standard dressings. While four studies reported equivalent SSI rates between patients who received NPWT compared with standard dressings, [130][131][132][133] it is important to note that three of these studies were small-scale retrospective analyses. [131][132][133] In contrast, both randomized controlled trials that made this comparison reported decreased SSI rates in patients who received NPWT compared with standard occlusive dressings.…”

“…While four studies reported equivalent SSI rates between patients who received NPWT compared with standard dressings, [130][131][132][133] it is important to note that three of these studies were small-scale retrospective analyses. [131][132][133] In contrast, both randomized controlled trials that made this comparison reported decreased SSI rates in patients who received NPWT compared with standard occlusive dressings. 46,134 Among the four studies that evaluated the PICO system, [135][136][137][138] three reported decreased SSI rates and one found similar rates between groups (see ►Table 5).…”

Clinical Applications and Benefits of Using Closed-incision Negative Pressure Therapy with Novel Dressing: A Review Article

“…Experiments and experiences with CINPT have proved useful in the development of a consensus among panels constituted by surgeons [25]. It is estimated that over the past decade, not using ciNPT has increased the cost of treatment for each patient, given the more extended hospitalization stays.…”

Negative Pressure Incisional Therapy and Postoperative Infection after Posterior Approach Primary Total Hip Arthroplasty

“…Closed incision negative pressure wound therapy (ciNPWT) has been used as a measure to decrease wound drainage, which could potentially help to reduce deep infection [17,18]. These types of dressings have been historically used for complications, non-healing wounds, or as adjuncts between wound debridement and definitive surgical closure [19,20].…”

“…Currently, the use of negative pressure dressings is accepted for the prophylaxis of wound complications in closed surgical wounds in high risk patients. We have previously analyzed the efficacy of negative pressure dressings in primary anterior total hip arthroplasty [18]. There are no specific guidelines that outline indications for the use of incisional negative pressure dressings after primary posterior approach THA.…”