Use of Closed Incisional Negative Pressure Wound Therapy After Revision Total Hip and Knee Arthroplasty in Patients at High Risk for Infection: A Prospective, Randomized Clinical Trial

Abstract

Background: Continuous wound drainage after arthroplasty can lead to the development of a periprosthetic joint infection. Closed incisional negative pressure wound therapy (ciNPWT) has been reported to help alleviate drainage and other wound complications. The purpose of this prospective randomized controlled trial is to compare the use of ciNPWT with our standard of care dressing in revision arthroplasty patients who were at high risk to develop wound complications. Methods: A total of 160 patients undergoing elective revision arthroplasty were prospectively randomized to receive either ciNPWT or a silver-impregnated occlusive dressing after surgery in a single institution. Patients were included if they had at least 1 risk factor for developing wound complication(s): wound complication, readmission, and reoperation rates were collected at 2, 4, and 12 weeks postoperatively. Results: The postoperative wound complication rate was significantly higher in the control cohort compared to the ciNPWT cohort (19 [23.8%] vs 8 [10.1%], P ¼ .022). There was no significant difference between the control and ciNPWT cohorts in terms of readmissions (19 [23.8%] vs 16 [20.3%], P ¼ .595). Reoperation rate was higher in controls compared to ciNPWT patients (10 [12.5%] vs 2 [2.5%], P ¼ .017). After adjusting for the history of a prior periprosthetic joint infection and inflammatory arthritis, the ciNPWT cohort had a significantly decreased wound complication rate (odds ratio 0.28, 95% confidence interval 0.11-0.68). Conclusion: ciNPWT may decrease the rate of postoperative wound complications in patients who are at an increased risk of such wound issues after revision arthroplasty.

Are high‐risk patient and revision arthroplasty effective indications for closed‐incisional negative‐pressure wound therapy after total hip or knee arthroplasty? A systematic review and meta‐analysis

“…Because patients with certain risk factors are frequently associated with SSCs, a variety of dressing materials were applied to prevent SSCs. 4,12,13 However, the proper indication and the best choice of dressing materials for wound management after THA and TKA still remains unclear.…”

Incisional Negative Pressure Wound Therapy Dressing in Total Joint Arthroplasty: what is the evidence? A Meta-Analysis

“…Our meta-analysis defined complication as minor or major. Some studies indicated that iNPWT had an effect on decreasing complications but there were some studies reporting the opposite efficacy [18,21,23]. In this meta-analysis, no difference in overall, minor and major complications were found after TJA.…”

“…However, the effect of application of diverse wound dressings remain unclear. Some present studies found that iNPWT has an advantage on wound healing [5,21]. A previous systematic review [22] evaluating the prophylactic use of iNPWT for wound complications in several surgical fields such as laparotomy for abdominal, coronary arteries bypass grafting, and lymphadenectomy.…”

“…However, there was limited studies on the application of iNPWT in orthopedic surgery. Newman et al [21] conducted a RCT on application of iNPWT compared with silverimpregnated occlusive dressing for revision total hip or knee arthroplasty in patients at high risk for infection. This study found that iNPWT may decrease the rate of postoperative wound complications.…”

Closed Incision Negative Pressure Therapy: Review of the Literature

“…The successful application of ciNPT on clean, closed wounds has been reported in a broad spectrum of patients and operative interventions resulting in positive clinical results in a majority of the RCTs identified in the literature search ( Table 2) [11][12][13][14][15][16][17][18][19]. Similarly, rates of SSIs, surgical site complications, readmissions, and/or reoperations were reduced in patients receiving ciNPT compared to historical control populations [20][21][22][23][24][25].…”