Paper of the Week: Closed Incision Negative Pressure Therapy Effects on Postoperative Infection and Surgical Site Complication After Total Hip and Knee Arthroplasty
Redfern RE, Cameron-Ruetz C, O’Drobinak SK, Chen JT, Beer KJ
The Journal of Arthroplasty 32 (2017): 3333-3339
DOI: 10.1016/j.arth.2017.06.019.
Summary by: Joseph Brutico, BS
While the incidence of periprosthetic joint infection remains low after total joint arthroplasty, it is the third leading cause of prosthesis failure [1]. Revision arthroplasty imparts a significant economic burden on insurance, and in some cases, patients [2]. Negative pressure therapy may be a promising technique for infection control as its use in lower extremity fractures has been shown to significantly decrease wound dehiscence and surgical site infections (SSI) [8]. However, few studies have examined its effects after total joint arthroplasty.
In this study, Redfern et al. examined the effects of closed incision negative pressure therapy (ciNPT; Prevena Incision Management System, Acelity, San Antonio, Tx) on wound complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA). From 2013-2014, 192 consecutive patients were treated with ciNPT for 6-8 days postoperatively. A cohort of 400 patients who underwent THA or TKA from 2011 to 2012 were retrospectively identified as the control group. All patients were treated by a single surgeon and physician assistant.
The total rate of complications, defined as a surgical site complication requiring medical or surgical intervention, was significantly higher in the control group (5.5% vs 1.5%, p = 0.02). Surgical site infections (SSI) was significantly lower in the ciNPT group (1.0% vs 3.5%, p = 0.04), while the rate of deep SSI was not statistically different (p = 0.81). Patients in the control group were also more likely to require intervention for hematomas (p = 0.02) and edema/swelling (p = 0.02). In addition, two (0.5%) patients in the control group developed clinically significant seromas. No patient in the ciNPT developed a seroma. Finally, the surrounding tissue of the ciNPT was more likely to be graded as normal (p = 0.003) compared to the control group.
The authors acknowledged limitations of their study. First, patients were treated at one institution by a single surgeon, leading to the results not being easily generalizable to an outside institution. Second, the prospective, non-blinded design was subject to observer bias. And lastly, the use of a historical cohort may have led to differences in demographics and comorbidities between the two groups. Complications related to the control group were gathered via retrospective chart review and therefore depended upon the quality and accuracy of documentation. The authors concluded that the rate of superficial infection, hematoma formation, and overall complications requiring intervention was significantly lower in the ciNPT group. However, further analysis regarding ciNPT after arthroplasty is warranted.
References:
- Parvizi J, Fassihi SC, Enayatollahi MA. Diagnosis of Periprosthetic Joint Infection Following Hip and Knee Arthroplasty. Orthop Clin North Am. 2016 Jul;47(3):505-15. doi: 10.1016/j.ocl.2016.03.001. Epub 2016 Apr 22. PMID: 27241375.
- Ong KL, Mowat FS, Chan N, Lau E, Halpern MT, Kurtz SM. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res. 2006 May;446:22-8. doi: 10.1097/01.blo.0000214439.95268.59. PMID: 16672867.
- Stannard JP, Volgas DA, McGwin G 3rd, Stewart RL, Obremskey W, Moore T, Anglen JO. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma. 2012 Jan;26(1):37-42. doi: 10.1097/BOT.0b013e318216b1e5. PMID: 21804414.
