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.

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 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;  = .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 ( = .00001 and  = .002, respectively) when compared to low-pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. ( = .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.