Comparison of the Efficacy Between Closed Incisional Negative-Pressure Wound Therapy and Conventional Wound Management After Total Hip and Knee Arthroplasties: A Systematic Review and Meta-Analysis |
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| Institution: | 1. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea;1. School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia;2. NHMRC Centre of Research Excellence in Nursing, Griffith University, Gold Coast, Queensland, Australia;3. Menzies Health Institute Queensland, Gold Coast, Queensland, Australia;4. Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK;1. The Orthopaedic Research Institute of Queensland (ORIQL), Pimlico, Queensland, Australia;2. Mater Health Services North Queensland Ltd, Pimlico, Queensland, Australia;3. The Orthopaedic Department, The Townsville Hospital, Townsville, Queensland, Australia;1. Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA;2. Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA;3. Department of Orthopedic Surgery, Sierra Pacific Orthopedic Center, Fresno, CA;4. Department of Plastic Surgery, Lenox Hill Hospital, New York, NY;5. Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY;1. Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY;2. 3M Company, St. Paul, MN;3. University of Maryland School of Medicine, Baltimore, MD |
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| Abstract: | BackgroundWound-related problems after total hip arthroplasty (THA) and total knee arthroplasty (TKA) can cause periprosthetic joint infections. We sought to evaluate the effect of closed incisional negative-pressure wound therapy (ciNPWT) on wound complications, skin blisters, surgical site infections (SSIs), reoperations, and length of hospitalization (LOH).MethodsStudies comparing ciNPWT with conventional dressings following THA and TKA were systematically searched on MEDLINE, Embase, and the Cochrane Library. Two reviewers performed the study selection, risk of bias assessment, and data extraction. Funnel plots were employed to evaluate publication bias and forest plots to analyze pooled data.ResultsTwelve studies were included herein. The odds ratios (ORs) for wound complications and SSIs indicated a lack of publication bias. ciNPWT showed significantly lower risks of wound complication (OR, 0.44; 95% confidence interval CI], 0.22-0.9; P = .027) and SSI (OR, 0.39; 95% CI, 0.23-0.68; P < .001) than did conventional dressings. ciNPWT also yielded a significantly lower reoperation rate (OR, 0.38; 95% CI, 0.21-0.69; P = .001) and shorter LOH (mean difference, 0.41 days; 95% CI, ?0.51 to ?0.32; P < .001). However, the rate of skin blisters was higher in ciNPWT (OR, 4.44; 95% CI, 2.24-8.79; P < .001).ConclusionAlthough skin blisters were more likely to develop in ciNPWT, the risks of wound complication, SSI, reoperation, and longer LOH decreased in ciNPWT compared with those in conventional dressings. This finding could alleviate the potential concerns regarding wound-related problems after THA and TKA. |
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| Keywords: | closed incisional negative-pressure wound therapy surgical site infection total hip arthroplasty total knee arthroplasty wound complication |
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