Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials

Kareem G Elhage; Mohamed E Awad; Furqan B Irfan; Joshua Lumbley; Gamal Mostafa; Khaled J Saleh

doi:10.1002/hsr2.425

Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials

Health Sci Rep. 2022 Jan 23;5(1):e425. doi: 10.1002/hsr2.425. eCollection 2022 Jan.

Authors

Kareem G Elhage^{1

2}, Mohamed E Awad^{1

3

4}, Furqan B Irfan⁴, Joshua Lumbley³, Gamal Mostafa^{2

5}, Khaled J Saleh^{1

4

5}

Affiliations

¹ FAJR Scientific Northville Michigan 48167 USA.
² Wayne State University, School of Medicine Detroit Michigan USA.
³ NorthStar Anesthesia-Detroit Medical center Detroit Michigan USA.
⁴ Michigan State University, College of Osteopathic Medicine Detroit Michigan USA.
⁵ Surgical Outcomes Research Institute, John D. Dingell VA Medical Center Detroit Michigan USA.

Abstract

Background: Closed-incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta-analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at -125 mmHg or -80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty.

Methods: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non-stratified and stratified meta-analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant.

Results: The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (-125 mmHg) (63.1%) and PICO dressing (-80 mmHg) (36.8%). The non-stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta-analysis indicated that patients undergoing treatment with high-pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low-pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005).

Conclusion: When compared to conventional wound dressing and -80 mmHg ciNPT, the use of -125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.

Keywords: conventional dressing; negative pressure wound therapy; surgical site complications; total hip arthroplasty; total knee arthroplasty.