Department of Value and Evidence, EVERSANA, Burlington, Ontario, Canada.
University of Utah Orthopaedic Center, Salt Lake City, Utah.
J Arthroplasty. 2025 Jan;40(1):111-118.e1. doi: 10.1016/j.arth.2024.06.057. Epub 2024 Jul 6.
Effective surgical wound management in total knee arthroplasty (TKA) is crucial for optimal healing and patient outcomes. Despite surgical advances, managing wounds to prevent complications remains challenging. This study aimed to identify and address evidence gaps in TKA wound management, including preoperative optimization, intraoperative options, and postoperative complication avoidance. Addressing these issues is vital for patient recovery and surgical success.
This study used the Delphi method with 20 experienced orthopedic surgeons from Europe and North America. Conducted from April to September 2023, the process involved three stages: an initial electronic survey, a virtual meeting, and a concluding electronic survey. The panel reviewed and reached a consensus on 26 statements about TKA wound management based on a comprehensive literature review. Additionally, the panel aimed to identify critical evidence gaps in wound management practices.
The panel achieved consensus on various wound management practices but highlighted significant evidence gaps. Consensus was reached on wound closure methods, including mesh-adhesive dressings, skin glue, staples, barbed sutures, and negative pressure wound therapy. However, further evidence is needed to address the cost-effectiveness of these methods and develop best practices for patient outcomes. Identifying these gaps highlights the need for more research to improve TKA wound care.
Identifying major evidence gaps underscores the need for targeted research in TKA wound management. Addressing these gaps is crucial for developing effective, efficient, and patient-friendly wound care strategies. Future research should focus on comparative effectiveness studies and developing guidelines for emerging technologies. Bridging these gaps could improve patient outcomes, reduce complications, and enhance TKA surgery success.
全膝关节置换术（TKA）中有效的手术伤口管理对于最佳愈合和患者结果至关重要。尽管手术有所进步，但管理伤口以预防并发症仍然具有挑战性。本研究旨在确定并解决 TKA 伤口管理中的证据空白，包括术前优化、术中选择和术后并发症避免。解决这些问题对于患者康复和手术成功至关重要。
本研究使用了来自欧洲和北美的 20 名经验丰富的骨科医生的 Delphi 方法。该过程于 2023 年 4 月至 9 月进行，包括三个阶段：初始电子调查、虚拟会议和最终电子调查。该小组根据全面的文献综述，对 26 条关于 TKA 伤口管理的声明进行了审查并达成共识。此外，该小组旨在确定伤口管理实践中的关键证据空白。
该小组就各种伤口管理实践达成了共识，但强调了重大的证据空白。在伤口闭合方法方面达成了共识，包括网片-粘合剂敷料、皮肤胶、订书钉、倒钩缝线和负压伤口治疗。然而，需要更多的证据来解决这些方法的成本效益，并为患者结果制定最佳实践。确定这些差距突出表明需要更多的研究来改善 TKA 伤口护理。
确定主要的证据差距突出了 TKA 伤口管理中需要有针对性的研究。解决这些差距对于开发有效、高效和以患者为中心的伤口护理策略至关重要。未来的研究应侧重于比较有效性研究和制定新兴技术指南。缩小这些差距可以改善患者的结果，减少并发症，并提高 TKA 手术的成功率。
