Are high‐risk patient and revision arthroplasty effective indications for closed‐incisional negative‐pressure wound therapy after total hip or knee arthroplasty? A systematic review and meta‐analysis

Abstract

To determine the effective indications of closed‐incisional negative‐pressure wound therapy (ciNPWT) following total hip or knee arthroplasty, this systematic review and meta‐analysis was conducted. The systematic search was performed on MEDLINE, Embase, and Cochrane Library, and 11 studies were included. The studies comparing between ciNPWT and conventional dressings were categorised into following subgroups based on patient risk and revision procedures: routine vs high‐risk patient; primary vs revision arthroplasty. Pooled estimates were calculated for wound complication and surgical site infection (SSI) rates in the subgroup analyses using Review Manager. In high‐risk patients, the overall rates of wound complication (odds ratio [OR] = 0.38; 95% confidence interval [CI] 0.15‐0.93; P = .030) and SSI (OR = 0.24; 95% CI = 0.09‐0.64; P = .005) were significantly lower in the ciNPWT; however, there were no differences in routine patients. In cases involving revision arthroplasties, the overall rates of wound complication (OR = 0.33; 95% CI = 0.18‐0.62; P < .001) and SSI (OR = 0.26; 95% CI = 0.11‐0.66; P = .004) were significantly lower in the ciNPWT; however, there were no differences in cases involving primary arthroplasties. In summary, ciNPWT showed a positive effect in decreasing the rates of wound complication and SSI in high‐risk patients and in revision arthroplasties.

Negative pressure wound therapy compared with conventional wound dressings for closed incisions in orthopaedic trauma surgery: A meta‐analysis

“…Also, additional studies are required to provide a clinically meaningful difference in the outcomes. This was also suggested in previous similar meta‐analysis studies, which showed a similar effect of negative pressure wound therapy and conventional wound dressings in subjects with different types of orthopaedic trauma surgery 32‐40 . The insignificant results of negative pressure wound therapy in the length of hospital stay also need additional study and clarification because no clear reasoning was found to clarify these outcomes.…”

“…This was also suggested in previous similar meta-analysis studies, which showed a similar effect of negative pressure wound therapy and conventional wound dressings in subjects with different types of orthopaedic trauma surgery. [32][33][34][35][36][37][38][39][40] The insignificant results of negative pressure wound therapy in the length of hospital stay also need additional study and clarification because no clear reasoning was found to clarify these outcomes. Wellconducted studies are also required to measure these factors and the blend of different ages and ethnicity, because our meta-analysis study could not answer whether they are related to the outcomes.…”

The application of close incisional negative pressure wound therapy in revision arthroplasty among asian patients: a comparative study

“…A recent meta-analysis of 11 studies on ciNPWT in knee or hip arthroplasty (including 8 randomized trials and 3 comparative cohort studies) found that ciNPWT could significantly reduce the incidence of wound complication and SSI in high-risk patients, and patients undergoing revision arthroplasties when compared with conventional dressing [ 25 ]. Among the high-risk patients, the ciNPWT cohort had significantly lower rates of wound complication (OR = 0.38, p = 0.030) and SSI (OR = 0.24, p = 0.005).…”

Analysis of Failed Two-Stage Procedures with Resection Arthroplasty as the First Stage in Periprosthetic Hip Joint Infections

“…Wound leakage is a sign of persistent infection and requires repeat debridement [ 22 ]. Negative-pressure wound therapy (NPWT) could be used in medically unfit patients, but its effectiveness is unknown [ 12 , 23 , 24 , 25 , 26 ]. In general, outcome studies in patient groups with PJIs are hard to compare due to their heterogeneous characteristics.…”

“…For the management of PJIs and to predict the outcome of PJIs, all potential risk factors should be considered and evaluated [ 3 ]. There are several reported studies about factors associated with the treatment outcome in patients with spacer implantation as the first-stage procedure [ 17 , 26 ]. However, there is limited literature available regarding possible risk factors associated with failed resection arthroplasties as a first-stage procedure.…”