Negative pressure wound therapy is associated with resolution of incisional drainage in most wounds after hip arthroplasty

Abstract

Background: Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty.

Questions/purposes: We determined (1) the rate of wound complications related to use of NPWT for persistent incisional drainage after hip arthroplasty; (2) the rate of resolution of incisional drainage using this modality; and (3) risk factors for failure of NPWT for this indication.

Methods: In a pilot study we identified 109 patients in whom NPWT was used after hip arthroplasty for treating postoperative incisional drainage between April 2006 and April 2010. On average, the NPWT was placed on postoperative Day 3 to 4 (range, 2-9 days) and applied for 2 days (range, 1-10 days). We then determined predictors of subsequent surgery. Patients were followed until failure or a minimum of 1 year (average, 29 months; range, 1-62 months).

Results: Eighty-three patients (76%) had no further surgery and 26 patients (24%) had subsequent surgery: 11 had superficial irrigation and débridement (I&D), 12 had deep I&D with none requiring further surgery, and three ultimately had component removal. Predictors of subsequent surgery included international normalized ratio level greater than 2, greater than one prior hip surgery, and device application greater than 48 hours. There were no wound-related complications associated with NPWT.

Conclusions: The majority of our patients had cessation of wound drainage with NPWT.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–B

Clinical images of the application of the NPWT for incisional drainage after hip arthroplasty. (A) Strips of the adhesive are placed around the perimeter of the incision to prevent skin edge maceration. (B) The sponge, cut to the length of the incision, is covered by a second layer of adhesive and the suction tubing is applied.

Fig. 2

Graph depicting the application of the NPWT based on POD. In the majority of cases, the NPWT was placed on POD 3 to 4.

Fig. 3

Graph depicting the length of application of the NPWT. In the majority of cases, the NPWT was applied for 48 hours.

Fig. 4

The flowchart illustrates the clinical outcomes after use of the NPWT for persistent wound drainage after hip arthroplasty. In 76% of patients, a dry wound was achieved after NPWT application. Of those that required surgery, 88% were successfully treated with isolated I&D. Only three patients underwent two-stage exchange arthroplasty. Sx = symptoms.