In search of the optimal wound dressing material following total hip and knee arthroplasty: a systematic review and meta-analysis

Abstract

Background: Various types of dressing materials are available for wound care following hip and knee arthroplasty. However, it is unclear if one material is more beneficial than the others in terms of wound complications and fluid handling capacity.

Research questions: We performed a meta-analysis of randomized controlled trials comparing alternative wound dressing materials for the post-operative management of wounds following THA and TKA with respect to (1) incidence of wound complications including infection and (2) fluid handling capacity.

Methods: Randomized controlled trials comparing alternative dressing materials, for post-operative management of wounds following TKA and THA were included in the review. Databases searched included the MEDLINE and the EMBASE from inception to February 2017. Two authors performed study selection, risk of bias assessment and data extraction. Where levels of clinical and statistical heterogeneity permitted, data were pooled for meta-analysis.

Results: Twelve randomized trials with data for the primary outcome were identified. Data were available for meta-analysis for two comparisons. Wounds managed with film dressings (odds ratio, 0.35; 95% confidence interval [CI], 0.21-0.57) or with hydrofiber dressings (odds ratio, 0.28; 95% confidence interval [CI], 0.20-0.40) were significantly less likely to have wound complications than those managed with passive dressings. There was no evidence that any dressing significantly reduced surgical-site infection rates compared with any other dressing. Hydrofibre dressings showed better fluid handling capacity than passive dressings in terms of mean number of dressing changes (mean difference 1.36; 95% confidence interval [CI], 0.15-2.57) and number of patients requiring early dressing change (odds ratio, 8.60; 95% confidence interval [CI], 4.68-15.83).

Conclusion: The evidence available in the current literature suggests that advanced dressings such as film and Hydrofibre dressings have fewer wound complications and better fluid handling capacity. However, insufficient evidence is available to determine whether the use of these advanced dressings reduce periprosthetic joint infection.

Keywords: Dressings; Total hip arthroplasty; Total knee arthroplasty; Wound complications.