The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention

Abstract

Background: Wound healing complications are causal factors of prosthesis infection and poor postoperative evolution of patients after total knee arthroplasty (TKA). Negative-pressure wound therapy (NPWT) can be an option to minimize these complications. The aim of this study is to compare the complications of patients undergoing TKA who used a portable NPWT device in the immediate postoperative period with those of a control group. Methods: A total of 296 patients were evaluated. Patients were divided into two groups: those who used NPWT for seven days in the postoperative period (Group 1prospective evaluated) and those who used conventional dressings (Group 2historical control group). Epidemiological data, comorbidities, local parameters related to the surgical wound and complications were evaluated. Results: The groups did not differ in regard to sex, age and clinical comorbidities. Overall, 153 (51.7%) patients had at least one risk factor for wound complications. Patients who used NPWT had a lower rate of complications (28.5% vs. 45.7%, p = 0.001) and a lower rate of reintervention in the operating room (2% vs. 8.5%, p = 0.001). Patients in group 1 had a lower incidence of hyperaemia (14.7% vs. 40.2%, p = 0.01), skin necrosis (2.1% vs. 8.5%, p = 0.04) and wound dehiscence (3.1% vs 10.1%, p = 0.03). The use of NPWT was a protective factor for the presence of complications, with an odds ratio of 0.36 (95% CI 0.206-0.629). Conclusion: The number of complications related to the wound after TKA is high; however, most of them are minor and have no impact on the treatment and clinical evolution of patients. The use of NPWT decreased the number of surgical wound complications, especially hyperaemia, dehiscence and necrosis, and reduced the need for reintervention.

Fatores associados ao desenvolvimento de complicações precoces após artroplastia total do joelho

“… 10 Among the comorbidities, it is worth noting that patients with diabetes mellitus had more complications in general, according to literature data, especially complications related to wound dehiscence and infections. 15 16 It was observed in the present study that patients with heart condition had a higher risk of developing arthrofibrosis, probably due to the difficulty in performing adequate rehabilitation, but further studies should be carried out to research this association. 3 13 No other comorbidity was able to independently change the overall risk of complications with statistical significance, probably due to the small sample size of the subgroups of those pathologies in the observed sample.…”

“… 10 Dentre as comorbidades, vale notar que os pacientes portadores de diabetes mellitus apresentaram mais complicações em geral segundo dados da literatura, especialmente as complicações relacionadas com deiscência de feridas e infecções. 15 16 Observou-se no presente estudo que pacientes cardiopatas apresentaram maior risco de desenvolver artrofibrose, provavelmente por dificuldade de realizar uma reabilitação adequada, mas novos estudos devem ser realizados para investigas tal associação. 3 13 Nenhuma outra comorbidade foi capaz de alterar o risco de complicações em geral com significância estatística independentemente, provavelmente devido ao pequeno tamanho amostral dos subgrupos destas patologias na amostra observada.…”

The Utility of Perioperative Products for the Prevention of Surgical Site Infections in Total Knee Arthroplasty and Lower Extremity Arthroplasty: A Systematic Review

“…[131][132][133] In contrast, both randomized controlled trials that made this comparison reported decreased SSI rates in patients who received NPWT compared with standard occlusive dressings. 46,134 Among the four studies that evaluated the PICO system, [135][136][137][138] three reported decreased SSI rates and one found similar rates between groups (see ►Table 5).…”

Correlation of patient-reported numbness around surgical scars with patient-reported outcome measures and joint awareness after knee replacement: a cohort study

“…Major complications, such as deep infection, loosening, and instability, often require revision surgery, whereas minor complications, such as discomfort around the scar [ 10 ] and noise from the knee [ 11 ], seldom require revision. In addition, minor complications related to wounds are relatively common [ 12 ], and wound-related complications have potential risks of developing into major complications that require further surgery. Other researchers have reported that 46–98% of patients who underwent knee replacement complained of numbness around the knee postoperatively [ 10 , 13 , 14 ].…”