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Comparative Study
. 2024 Sep 16;12(9).
doi: 10.2106/JBJS.RVW.24.00115. eCollection 2024 Sep 1.

A Comparison of Incisional Dressings and Negative-Pressure Wound Therapy for the Prevention of Infection and Wound Complications After Primary Total Hip and Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials

Charles Gusho  1 , Wayne Hoskins, Elie Ghanem
Affiliations
Comparative Study

A Comparison of Incisional Dressings and Negative-Pressure Wound Therapy for the Prevention of Infection and Wound Complications After Primary Total Hip and Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials

Charles Gusho et al. JBJS Rev. .

Abstract

Background: Incisional dressings may decrease wound complications and joint infection after total hip and knee arthroplasties (THA; TKA). However, there is no consensus on the superiority of a particular product. This study compared infection and wound complications among randomized controlled trials (RCTs) across various dressing types after primary THA and TKA.

Methods: Scopus, Ovid/MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were queried in May 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared minor and major wound complications and dressing changes using P-scores.

Results: Of 3,067 compiled studies, 12 RCTs of 1,939 patients with median (interquartile range) follow-up of 42 (382) days undergoing primary THA (n = 880, 45.4%) or TKA (n = 1,059, 54.6%) with alginate (n = 208; 10.7%), absorbent (n = 236; 12.2%), gauze (n = 474; 24.4%), or hydrofiber (n = 683; 35.2%) dressings or negative-pressure wound therapy (NPWT; n = 338; 17.4%) were included for meta-analysis. Compared with gauze, alginate and hydrofiber dressings were associated with fewer postoperative changes (mean difference [MD], -12.1; 95% confidence interval [CI], -15.08 to -9.09, p < 0.001; MD, -3.5; 95% CI, -6.30 to -0.74, p = 0.013, respectively). In a subanalysis, silver-ion hydrofiber also was associated with fewer changes (MD, -5.0; 95% CI, -5.70 to -4.39; p < 0.001). Overall, there was no statistically significant risk of increased minor nor major wound complications including superficial and deep infections among all dressing types and NPWT compared with gauze.

Conclusion: Despite no association between wound complications nor infection risk among various incisional dressings and NPWT vs. gauze, the alginate, hydrofiber, and silver hydrofiber dressings had statistically fewer mean postoperative changes. Future studies are required to assess whether these dressings confer reduced infection risk.

Level of evidence: Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B158).

References

    1. Beam E, Osmon D. Prosthetic joint infection update. Infect Dis Clin North Am. 2018;32(4):843-59.
    1. Aboltins CA, Berdal JE, Casas F, Corona PS, Cuellar D, Ferrari MC, Hendershot E, Huang W, Kuo FC, Malkani A, Reyes F, Rudelli S, Safir O, Seyler T, Tan TL, Townsend R, Tuncay I, Turner D, Winkler H, Wouthuyzen-Bakker M, Yates AJ, Zahar A. Hip and knee section, prevention, antimicrobials (systemic): proceedings of international consensus on orthopedic infections. J Arthroplasty. 2019;34(2, suppl):S279-88.
    1. Chowdhry M, Chen AF. Wound dressings for primary and revision total joint arthroplasty. Ann Transl Med. 2015;3(18):268.
    1. Sharma G, Lee SW, Atanacio O, Parvizi J, Kim TK. In search of the optimal wound dressing material following total hip and knee arthroplasty: a systematic review and meta-analysis. Int Orthop. 2017;41(7):1295-305.
    1. Rothfusz CA, Emara AK, McLaughlin JP, Molloy RM, Krebs VE, Piuzzi NS. Wound dressings for hip and knee total joint arthroplasty: a narrative review. JBJS Rev. 2021;9(7):e20.00301.

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