International panel reveals wound closure, dressing management consensus for TJA
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Key takeaways:
- A panel of orthopedic surgeons published consensus statements on optimal wound closure and dressing management in hip and knee arthroplasty.
- The panel included surgeons from the United States, Europe and Canada.
Results presented at the Musculoskeletal Infection Society Annual Meeting revealed 40 international Delphi consensus statements on wound closure and dressing management in total hip and knee arthroplasty.
Antonia F. Chen, MD, MBA, associate professor of orthopedic surgery at Brigham and Women’s Hospital, and a panel of 20 orthopedic surgeons from the United States, Europe and Canada performed a modified Delphi study to determine a consensus on several topics related to optimal wound closure and dressing management in THA and TKA. To achieve a consensus, panelists completed three rounds of anonymous voting on statements derived from four published systematic reviews.
The panel voted on topics including closure methods, tourniquets, drains, venous thromboembolism prophylaxis, dressings, suture types, surgical techniques and postoperative care.
Among the TKA consensus statements, the panel concluded that closures done in semi-flexion were superior vs. those done in extension, according to Chen. In addition, Chen said the panel agreed that aspirin leads to fewer wound complications vs. other methods of chemoprophylaxis. She also said barbed sutures were associated with a reduced risk of wound complications and reduced closing time vs. interrupted closure with non-barbed sutures in both TKA and THA.
In her presentation, Chen said, “Barbed sutures may cost more than interrupted closure, but there are potential cost savings due to faster closing time and reduced operating room time.”
Mesh adhesives were associated with faster closing times, higher patient satisfaction, reduced risk of wound complications, reduced readmission rates, fewer dressing changes and reduced risk of surgical site infection vs. other skin closure methods in TKA, according to Chen. Mesh adhesives were also associated with lower rates of wound complications vs. other skin closure methods in THA.
Chen said triclosan-coated sutures and negative pressure wound therapy can be beneficial in both THA and TKA.
“Using this Delphi approach and 20 surgeons, we had 40 total statements that were useful,” Chen said. “It can be applied to clinical practice, and it does form the basis of identifying critical evidence.”
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Chen AF, et al. Paper 1241. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 2-3, 2024; Durham, North Carolina (hybrid meeting).
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