Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee

Cooper, H. John; Roc, Gilbert C.; Bas, Marcel A.; Berliner, Zachary P.; Hepinstall, Matthew S.; Rodríguez, José A.; Weiner, Lon S.

doi:10.1016/j.injury.2017.11.010

Cited by 46 publications

(39 citation statements)

References 46 publications

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“…30,31 Although this infection rate is higher than those reported for index THR, deep surgical site infection rates between 4.4 and 25% are reported in people treated for periprosthetic femoral fractures. [32][33][34][35] Possible explanations for the high infection rate could be due to the development of resistance to prophylactically administered cephalexin, extensive soft tissue dissection, prolonged surgical time, fracture associated trauma to surrounding tissues or the presence of preexisting implants. 30,35 Femoral fracture revision was performed without entering the hip and with a stitched-in impervious stockinettes to minimize prosthesis infection.…”

Section: Discussionmentioning

confidence: 99%

“…[32][33][34][35] Possible explanations for the high infection rate could be due to the development of resistance to prophylactically administered cephalexin, extensive soft tissue dissection, prolonged surgical time, fracture associated trauma to surrounding tissues or the presence of preexisting implants. 30,35 Femoral fracture revision was performed without entering the hip and with a stitched-in impervious stockinettes to minimize prosthesis infection. Collection of exit cultures for revision procedures may be beneficial in these higher risk cases.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

Monotti

Preston²,

Kidd³

2020

Vet Comp Orthop Traumatol

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Objective The aim of this study was to report outcomes in dogs with periprosthetic femoral fractures associated with a press-fit cementless femoral total hip replacement implant. Methods Electronic medical records and digital radiographs were used to identify dogs with periprosthetic femoral fractures associated with press-fit cementless total hip replacement. Data collected included signalment, weight, time of fracture, cause of fracture, presence of intra-operative fissure, fracture type, repair technique, and clinical and radiographic outcomes. Long-term patient outcome was assessed by communication with owners or referring veterinarians. Results Twenty-eight dogs with femoral fracture repair associated with cementless press-fit total hip replacement were identified. Eight of the fractures occurred intraoperatively and 20 occurred at a median of 2 days postoperatively. An oblique or spiral configuration was noted in 19 cases and 15 occurred at the distal end of the femoral stem (type B), with thirteen type B1, one type B2 and one type B3 fractures. Fractures were repaired with non-locking (18/28) or locking-plate fixation (10/28). Cerclage wire was applied around the plate and proximal bone segment in 17/28 dogs. Major complications occurred in 7/28 cases (five deep infection, two mechanical failures). Bone healing was noted in 21/23 cases, for which follow-up radiographic interpretation was available. Return to function was complete in 17 cases, acceptable in 8 cases and unacceptable in 3 cases. Conclusions While cementless total hip replacement periprosthetic femoral fractures can be successfully repaired with lateral plate fixation, the risk of infection appears to be high.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

Monotti

Preston²,

Kidd³

2020

Vet Comp Orthop Traumatol

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“…The literature search identified 12 RCTs, a majority of which reported reduced SSI rates, reduced readmission rates, and reduced reoperation rates. Six of the non-RCT, comparative studies identified also reported reduced rates of SSIs, readmissions, and reoperations [20][21][22][23][24][25]. However, these studies examined a wide range of patients, with a variety of comorbidities, undergoing different surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The successful application of ciNPT on clean, closed wounds has been reported in a broad spectrum of patients and operative interventions resulting in positive clinical results in a majority of the RCTs identified in the literature search ( Table 2) [11][12][13][14][15][16][17][18][19]. Similarly, rates of SSIs, surgical site complications, readmissions, and/or reoperations were reduced in patients receiving ciNPT compared to historical control populations [20][21][22][23][24][25].…”

Section: Literature Searchmentioning

confidence: 95%

Closed Incision Negative Pressure Therapy: Review of the Literature

Fernández¹,

Matthews²,

Alvarez³

et al. 2019

Cureus

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Surgical site infection and other common surgical site complications (dehiscence, hematoma, and seroma formation) can lead to serious and often life-threatening complications. Gauze, adhesive dressings, and skin adhesives have traditionally been utilized for incision management. However, the application of negative pressure wound therapy over clean, closed surgical incisions (closed incision negative pressure therapy, ciNPT), has become a recent option for incision management. A brief review of ciNPT clinical evidence and health economic evidence are presented. A brief literature review was performed using available publication databases (PubMed, Ovid®, Embase®, and QUOSA™) for articles in English reporting on the use of ciNPT between October 1, 2016, to March 31, 2019. The successful application of ciNPT over clean, closed wounds has been reported in a broad spectrum of patients and operative interventions, resulting in favorable clinical results. Four of the five studies that examined health economics following the use of ciNPT reported a potential reduction in the cost of care. The authors' own experience and published results suggest that patients at high risk for developing a surgical site complication may benefit from the use of ciNPT during the immediate postoperative period. Additional studies are needed across various surgical disciplines to further assess the safety, and cost-effectiveness of ciNPT use in patient populations.

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“…Negative-pressure wound therapy (NPWT) is a form of adjuvant treatment that has been gaining attention recently in the orthopedic literature. Although its use is well established in other areas of medicine and orthopedics, especially in cases of trauma with severe lesions in soft parts and exposed fractures, 4 - 6 its use in the field of primary arthroplasties and prosthetic revision surgeries is still not well established. Studies of cases of periprosthetic fractures after knee and hip and ankle arthroplasties have demonstrated the benefit of using this type of therapy.…”

Section: Introductionmentioning

confidence: 99%

Incisional Negative-Pressure Wound Therapy in Revision Total Hip Arthroplasty Due to Infection

et al. 2018

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ObjectiveTo present our institution's experience with negative-pressure wound therapy (NPWT) as an adjuvant in wound healing of patients who have undergone revision total hip arthroplasty (THA) due to septic loosening in the presence of active fistula.MethodsWe prospectively assessed patients presenting with THA infection, associated with the presence of fistula, treated with a PICO® device for NPWT, in combination with the standard treatment for prosthesis infection in our institution. Resolution of the infectious process and healing of the surgical wound without complications were considered an initial favorable outcome.ResultsWe assessed 10 patients who used PICO® in our department. No complications were identified in association with the use of the NPWT device. The mean follow-up of the patients after use of the device was 12.7 months. Only one patient progressed with fistula reactivation and recurrence of infection.ConclusionNPWT can be used in wound complications and infection following THA procedures safely and with promising results. Randomized prospective studies should be conducted to confirm its effectiveness. Level of Evidence IV, Case Series.

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Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee

Cited by 46 publications

References 46 publications

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

Treatment Outcomes for Periprosthetic Femoral Fractures in Cementless Press-Fit Total Hip Replacement

Closed Incision Negative Pressure Therapy: Review of the Literature

Incisional Negative-Pressure Wound Therapy in Revision Total Hip Arthroplasty Due to Infection

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