Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Walsall Healthcare NHS Trust, Walsall, United Kingdom.
J Bone Joint Surg Am. 2020 Dec 24;Publish Ahead of Print:541-548. doi: 10.2106/JBJS.20.01254.
Negative pressure wound therapy (NPWT) has been used because of its perceived advantages in reducing surgical site infections, wound complications, and the need for further surgery. The purpose of this study was to assess the infection rates, wound complications, length of stay, and financial burden associated with NPWT use in primary and revision total knee arthroplasty (TKA).
We performed a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic review of the existing literature on using NPWT in primary and revision TKA. PubMed, Embase, Science Direct, and the Cochrane Library were utilized. The risk of bias was evaluated using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool, and the quality of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.
Twelve articles that evaluated 1,403 primary TKAs and 279 revision TKAs were reviewed. NPWT significantly reduced complication rates in revision TKA. However, there was no significant difference in infection rates between NPWT and regular dressings in primary or revision TKA. NPWT use in primary TKA significantly increased the risk of blistering, although no increase in reoperations was noted. The analysis showed a possible reduction in length of stay associated with NPWT use for both primary and revision TKA, with overall health-care cost savings.
Based on a meta-analysis of the existing literature, we do not recommend the routine use of NPWT. However, in high-risk revision TKA and selected primary TKA cases, NPWT reduced wound complications and may have health-care cost savings.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
负压伤口疗法（NPWT）因其在降低手术部位感染、伤口并发症和进一步手术需求方面的优势而被广泛应用。本研究旨在评估 NPWT 在初次和翻修全膝关节置换术（TKA）中的感染率、伤口并发症、住院时间和经济负担。
我们对 NPWT 在初次和翻修 TKA 中的应用进行了 PRISMA（系统评价和荟萃分析的首选报告项目）系统评价。检索了 PubMed、Embase、Science Direct 和 Cochrane Library。使用 ROBINS-I（非随机干预研究的偏倚风险评估工具）评估偏倚风险，并使用 GRADE（推荐评估、制定和评估分级）标准评估证据质量。
共评价了 12 篇评估 1403 例初次 TKA 和 279 例翻修 TKA 的文章。NPWT 可显著降低翻修 TKA 的并发症发生率。然而，NPWT 与常规敷料在初次或翻修 TKA 中的感染率无显著差异。NPWT 在初次 TKA 中的应用显著增加了水疱形成的风险，但未观察到再手术率增加。分析显示，NPWT 的使用可能与初次和翻修 TKA 的住院时间缩短有关，同时总体节省了医疗保健成本。
基于对现有文献的荟萃分析，我们不建议常规使用 NPWT。然而，在高危翻修 TKA 和特定的初次 TKA 病例中，NPWT 可减少伤口并发症，并可能节省医疗保健成本。
治疗性 III 级。请参阅作者指南以获取完整的证据水平描述。
