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. 2016 Aug;5(8):328-37.
doi: 10.1302/2046-3758.58.BJR-2016-0022.R1.

Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial

S L Karlakki  1 , A K Hamad  2 , C Whittall  2 , N M Graham  2 , R D Banerjee  2 , J H Kuiper  2
Affiliations

Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial

S L Karlakki et al. Bone Joint Res. 2016 Aug.

Abstract

Objectives: Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties.

Methods: A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group.

Results: An improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06).

Conclusions: Based on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res 2016;5:328-337. DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1.

Keywords: Incisional wound; NPWT; THA; TKA; Wound complications; iNPWTd.

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Conflict of interest statement

ICMJE conflict of interest: None declared.

Figures

Fig. 1
Fig. 1
The negative pressure wound therapy dressing used in the study, PICO.
Fig. 2
Fig. 2
Consolidated Standards of Reporting Trials diagram for negative pressure wound therapy (NPWT) dressings.
Fig. 3
Fig. 3
Distribution of peak exudate levels between the two study groups.
See this image and copyright information in PMC

References

    1. Norman-Taylor FH, Palmer CR, Villar RN. Quality-of-life improvement compared after hip and knee replacement. J Bone Joint Surg [Br] 1996;78-B:74-77. - PubMed
    1. Patel VP, Walsh M, Sehgal B, et al. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg [Am] 2007;89-A:33-38. - PubMed
    1. Weiss AP, Krackow KA. Persistent wound drainage after primary total knee arthroplasty. J Arthroplasty 1993;8:285-289. - PubMed
    1. Abudu A, Sivardeen KA, Grimer RJ, Pynsent PB, Noy M. The outcome of perioperative wound infection after total hip and knee arthroplasty. Int Orthop 2002;26:40-43. - PMC - PubMed
    1. Saleh K, Olson M, Resig S, et al. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 2002;20:506-515. - PubMed