Polyester Mesh with Liquid Adhesive Compared to Incisional Negative Pressure 2 Therapy for Direct Anterior Total Hip Arthroplasty in the 90-day Postoperative Period

Abstract

Some data suggest higher rates of superficial wound complications following direct anterior approach to total hip arthroplasty (DAA-THA) compared to other approaches, likely owing to proximity of the incision to the groin crease. Increased body mass index (BMI) has also been associated with increased superficial wound complications regardless of approach. We investigated superficial wound complications following DAA-THA comparing two different dressing types, polyester mesh (PM) with liquid adhesive and incisional negative pressure therapy (iNPT), with additional analysis of the association of BMI and medical comorbidities with wound complications in each dressing type cohort. Consecutive DAA-THAs were assessed (n = 711 total, 213 iNPT, 498 PM). Superficial or deep wound complications within 3 months of surgery were recorded. Demographics were compared using student’s t-test with Welch’s correction and Chi-square tests, where appropriate. Logistic regression on wound complication included the following variables: patient BMI, dressing type, active tobacco smoking, diabetes mellitus, liver disease, chronic kidney disease, and anemia. A p-value of < 0.05 was considered statistically significant. The overall rate of wound complication was 9.00%. Wound dehiscence was the most frequent complication, affecting 26 patients (3.66%) overall. Multiple logistic regression showed that BMI and tobacco smoking were associated with increased wound complications (aOR=1.072, p=0.007; aOR=3.258, p=0.009) and that PM use was associated with fewer wound complications when compared to iNPT (aOR=0.555, p=0.047). In this investigation, PM dressings after DAA-THA were associated with decreased risk of wound complication compared to iNPT. Secondarily, smoking and increased BMI were risk factors for postoperative wound complications.