Negative pressure wound therapy dressing minimized complications in TJA

Patients who had negative pressure wound therapy dressings had significant improvements.

Use of incisional negative pressure wound therapy dressings achieved predictable length of stay, eliminated excessive hospital stay and minimized wound complications in patients who underwent total hip and knee arthroplasty, according to study results.

“Predictability of wound healing and length of stay is enhanced by negative pressure wound therapy dressings in the setting of primary hip and knee replacement, and particularly beneficial in patients with high comorbidities and a BMI of 35 or greater in minimizing wound complications,” Sudheer L. Karlakki, FRCS(Orth), MSc(Orth Eng), LLM, a consultant orthopedic surgeon for the hip and knee, told Orthopedics Today.

Negative pressure wound therapy

Karlakki and his colleagues randomly assigned 220 patients undergoing elective primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) to receive either a PICO Single Use Negative Pressure Wound Therapy system dressing (Smith & Nephew) or conventional dressings.

The primary outcome was to measure the impact of incisional negative pressure wound therapy dressing on wound healing and its effect on length of stay (LOS), while secondary outcomes included assessment of wound complications such as prolonged wound exudate and superficial wound infections, number of dressing changes and the overall cost-effectiveness of the dressing used.

Results showed a significant difference in the level and number of peak exudates between the two groups. Compared with the control group, there were fewer patients with higher grades of peak exudate in the intervention group. Although researchers found no statistically significant reduction in overall LOS in the intervention group (0.9 days less LOS in intervention group), patients who received incisional negative pressure wound therapy dressing had a significant reduction in extremes of LOS. In other words, they had a more predictable LOS, Karlakki noted.

Overall, 5.2% of patients had surgical wound-related complications, which were mainly found in the control group and in TKAs. The intervention group had a four-fold reduction in postoperative wound complications compared with the control group, with the risk of wound complications increased by a higher BMI and American Society of Anesthesiologists grade, diabetes, smoking/former smoking and skin closure with staples. Patients in the study group also had a significant reduction in the mean number of dressing changes, researchers noted.

Cost analysis

The investigators were aware of the beneficial effects of negative pressure wound therapy dressings, but Karlakki said they had “hoped to see a reduction in wound discharge and an improvement in predictability of LOS.”

“Reduction in wound discharge was statistically significant, but not the overall average LOS,” Karlakki said.

“We are now in the process of looking at the cost-analysis aspects of these dressings,” he added. “The dressings do cost more than the traditional dressings at £125. We are also analyzing their effectiveness in managing patients with wound problems in the outpatient settings.” – by Casey Tingle

Disclosure: The study was financially supported by Smith & Nephew (dressings and cost of data collection). Karlakki reports he received payments for educational lectures from Smith & Nephew.

Use of incisional negative pressure wound therapy dressings achieved predictable length of stay, eliminated excessive hospital stay and minimized wound complications in patients who underwent total hip and knee arthroplasty, according to study results.

“Predictability of wound healing and length of stay is enhanced by negative pressure wound therapy dressings in the setting of primary hip and knee replacement, and particularly beneficial in patients with high comorbidities and a BMI of 35 or greater in minimizing wound complications,” Sudheer L. Karlakki, FRCS(Orth), MSc(Orth Eng), LLM, a consultant orthopedic surgeon for the hip and knee, told Orthopedics Today.

Negative pressure wound therapy

Karlakki and his colleagues randomly assigned 220 patients undergoing elective primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) to receive either a PICO Single Use Negative Pressure Wound Therapy system dressing (Smith & Nephew) or conventional dressings.

The primary outcome was to measure the impact of incisional negative pressure wound therapy dressing on wound healing and its effect on length of stay (LOS), while secondary outcomes included assessment of wound complications such as prolonged wound exudate and superficial wound infections, number of dressing changes and the overall cost-effectiveness of the dressing used.

Results showed a significant difference in the level and number of peak exudates between the two groups. Compared with the control group, there were fewer patients with higher grades of peak exudate in the intervention group. Although researchers found no statistically significant reduction in overall LOS in the intervention group (0.9 days less LOS in intervention group), patients who received incisional negative pressure wound therapy dressing had a significant reduction in extremes of LOS. In other words, they had a more predictable LOS, Karlakki noted.

Overall, 5.2% of patients had surgical wound-related complications, which were mainly found in the control group and in TKAs. The intervention group had a four-fold reduction in postoperative wound complications compared with the control group, with the risk of wound complications increased by a higher BMI and American Society of Anesthesiologists grade, diabetes, smoking/former smoking and skin closure with staples. Patients in the study group also had a significant reduction in the mean number of dressing changes, researchers noted.

Cost analysis

The investigators were aware of the beneficial effects of negative pressure wound therapy dressings, but Karlakki said they had “hoped to see a reduction in wound discharge and an improvement in predictability of LOS.”

“Reduction in wound discharge was statistically significant, but not the overall average LOS,” Karlakki said.

“We are now in the process of looking at the cost-analysis aspects of these dressings,” he added. “The dressings do cost more than the traditional dressings at £125. We are also analyzing their effectiveness in managing patients with wound problems in the outpatient settings.” – by Casey Tingle

Disclosure: The study was financially supported by Smith & Nephew (dressings and cost of data collection). Karlakki reports he received payments for educational lectures from Smith & Nephew.