Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
J Arthroplasty. 2023 Jun;38(6):1160-1165. doi: 10.1016/j.arth.2023.02.074. Epub 2023 Mar 5.
There is a lack of consensus on optimal skin closure and dressing strategies to reduce early wound complication rates after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
All 13,271 patients at low risk for wound complications undergoing primary, unilateral THA (7,816), and TKA (5,455) for idiopathic osteoarthritis at our institution between August 2016 and July 2021 were identified. Skin closure, dressing type, and postoperative events related to wound complications were recorded during the first 30 postoperative days.
The need for unscheduled office visits to address wound complications was more frequent after TKA than THA (2.74 versus 1.78%, P < .001), and after direct anterior versus posterior approach THA (2.94 versus 1.39%, P < .001). Patients who developed a wound complication, had a mean of 2.9 additional office visits. Compared to the use of topical adhesives, skin closure with staples had the highest risk of wound complications (odds ratio 1.8 [1.07-3.11], P = .028). Topical adhesives with polyester mesh had higher rates of allergic contact dermatitis than topical adhesives without mesh (1.4 versus 0.5%, P < .0001).
Wound complications after primary THA and TKA were often self-limited but increased burden on the patient, surgeon, and care team. These data, which suggest different rates of certain complications with different skin closure strategies, can inform a surgeon on optimal closure methods in their practice. Adoption of the skin closure technique with the lowest risk of complications in our hospital would conservatively result in a reduction of 95 unscheduled office visits and save a projected $585,678 annually.
在初次全髋关节置换术（THA）和全膝关节置换术（TKA）后，减少早期伤口并发症发生率方面，对于最佳皮肤缝合和敷料策略尚未达成共识。
在 2016 年 8 月至 2021 年 7 月期间，我们机构对患有特发性骨关节炎的低风险伤口并发症患者（THA：7816 例，TKA：5455 例）进行初次单侧 THA 和 TKA。记录了皮肤缝合、敷料类型以及术后 30 天内与伤口并发症相关的事件。
TKA 后需要非计划门诊就诊以处理伤口并发症的情况比 THA 更频繁（2.74%比 1.78%，P<.001），直接前侧入路 THA 比后侧入路 THA 更频繁（2.94%比 1.39%，P<.001）。发生伤口并发症的患者平均增加了 2.9 次门诊就诊。与使用局部黏合剂相比，皮肤缝合使用订书钉的伤口并发症风险最高（比值比 1.8 [1.07-3.11]，P=0.028）。与无网眼的局部黏合剂相比，带聚酯网眼的局部黏合剂发生过敏性接触性皮炎的比率更高（1.4%比 0.5%，P<.0001）。
初次 THA 和 TKA 后的伤口并发症通常是自限性的，但会增加患者、外科医生和护理团队的负担。这些数据表明，不同的皮肤缝合策略会导致不同的并发症发生率，可为外科医生提供在实践中采用最佳缝合方法的信息。如果在我们医院采用并发症风险最低的皮肤缝合技术，那么每年保守估计可减少 95 次非计划门诊就诊，节省 585678 美元。
