Closed incision negative pressure therapy may reduce surgical site complications after THA
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Closed incision negative pressure therapy may reduce the rate of surgical site complications among higher risk patients undergoing total hip arthroplasty with the direct anterior approach, according to results presented here.
In the prospective, multicenter, randomized controlled trial, H. John Cooper, MD, and colleagues randomly assigned 120 patients undergoing THA through the direct anterior approach to receive either a silver impregnated occlusive dressing or a closed incision negative pressure therapy dressing, which was maintained in place for 7 days postoperatively.
“Our primary outcome measure was the presence of any 90-day surgical site complication, including drainage, wound breakdown or necrosis, wound dehiscence or a superficial or deep surgical site infection, that required additional nonsurgical or surgical intervention beyond letting the wound heal,” Cooper said in his presentation at the American Association of Hip and Knee Surgeons Annual Meeting.
Cooper noted photos were obtained of each incision at 2 and 6 weeks postoperatively and at any additional office visits.
Patients in the silver impregnated occlusive dressing group had a surgical site complication rate of 18% vs. 8% among the closed incision negative pressure therapy group, according to Cooper.
“This 2.5-fold reduction did not achieve statistical significance in a study that was powered to look for a 4.5-fold difference,” Cooper said.
However, he noted results showed a significantly reduced rate of superficial surgical site infection, with a 15% rate found in the impregnated occlusive dressing group compared with a 3% rate found in the closed incision negative pressure therapy group. Cooper added one patient in the closed incision negative pressure therapy group underwent reoperation for deep infection.
“[Closed incision negative pressure therapy] may decrease one of the more common complications in patients with risk factors undergoing primary direct anterior approach total hip arthroplasty,” Cooper said.
Perspective
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The paper offers some insight into a possible wound management improvement in high-risk direct anterior THA using negative pressure dressings. The paper, however, failed to show statistical significance for one arm of the study vs. the other. There are other potential confounding factors, including possible differences in direct anterior technique and surgeon experience; those potential subgroup analyses were not offered in the abstract and would be difficult due to small numbers. The finding that further research is justified by this investigation is appropriate.
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Cooper HJ, et al. Paper 27. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 11-14, 2021; Dallas (hybrid meeting).
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