A Comparison of Incisional Dressings and Negative-Pressure Wound Therapy for the Prevention of Infection and Wound Complications After Primary Total Hip and Knee Arthroplasty: A Network Meta-Analysis of Randomized Controlled Trials.

IF 1.7 Q2 SURGERY

JBJS Reviews Pub Date : 2024-09-16 eCollection Date: 2024-09-01 DOI:10.2106/JBJS.RVW.24.00115

Charles Gusho, Wayne Hoskins, Elie Ghanem

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引用次数: 0

Abstract

Background: Incisional dressings may decrease wound complications and joint infection after total hip and knee arthroplasties (THA; TKA). However, there is no consensus on the superiority of a particular product. This study compared infection and wound complications among randomized controlled trials (RCTs) across various dressing types after primary THA and TKA.

Methods: Scopus, Ovid/MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were queried in May 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared minor and major wound complications and dressing changes using P-scores.

Results: Of 3,067 compiled studies, 12 RCTs of 1,939 patients with median (interquartile range) follow-up of 42 (382) days undergoing primary THA (n = 880, 45.4%) or TKA (n = 1,059, 54.6%) with alginate (n = 208; 10.7%), absorbent (n = 236; 12.2%), gauze (n = 474; 24.4%), or hydrofiber (n = 683; 35.2%) dressings or negative-pressure wound therapy (NPWT; n = 338; 17.4%) were included for meta-analysis. Compared with gauze, alginate and hydrofiber dressings were associated with fewer postoperative changes (mean difference [MD], -12.1; 95% confidence interval [CI], -15.08 to -9.09, p < 0.001; MD, -3.5; 95% CI, -6.30 to -0.74, p = 0.013, respectively). In a subanalysis, silver-ion hydrofiber also was associated with fewer changes (MD, -5.0; 95% CI, -5.70 to -4.39; p < 0.001). Overall, there was no statistically significant risk of increased minor nor major wound complications including superficial and deep infections among all dressing types and NPWT compared with gauze.

Conclusion: Despite no association between wound complications nor infection risk among various incisional dressings and NPWT vs. gauze, the alginate, hydrofiber, and silver hydrofiber dressings had statistically fewer mean postoperative changes. Future studies are required to assess whether these dressings confer reduced infection risk.

Level of evidence: Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.

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比较切口敷料和负压伤口疗法预防原发性全髋关节和膝关节置换术后感染和伤口并发症：随机对照试验网络元分析》。

背景：切口敷料可减少全髋关节和膝关节置换术（THA；TKA）后的伤口并发症和关节感染。然而，对于特定产品的优劣尚未达成共识。本研究比较了各种类型敷料在初次髋关节置换术（THA）和膝关节置换术（TKA）后的随机对照试验（RCT）中的感染和伤口并发症：方法：于 2024 年 5 月查询了 Scopus、Ovid/MEDLINE、PubMed、Cochrane 系统综述数据库和 Cochrane 对照试验中央登记册。对符合条件的前瞻性 RCT 进行频数模型网络荟萃分析，使用 P 值比较轻微和严重伤口并发症以及敷料更换情况：在汇编的 3067 项研究中，有 12 项研究对 1939 名患者进行了中位（四分位间距）随访，随访天数为 42 (382) 天，这些患者接受了初级 THA（n = 880，45.4%）或 TKA（n = 1,059, 54.6%），使用了藻酸盐（n = 208; 10.7%）、吸收剂（n = 236；12.2%）、纱布（n = 474；24.4%）或水纤维（n = 683；35.2%）敷料或负压伤口疗法（NPWT；n = 338；17.4%）进行荟萃分析。与纱布相比，藻酸盐和水纤维敷料的术后变化较小（平均差 [MD]，-12.1；95% 置信区间 [CI]，-15.08 至 -9.09，p < 0.001；MD，-3.5；95% 置信区间 [CI]，-6.30 至 -0.74，p = 0.013）。在一项子分析中，银离子水纤维也与较少的变化有关（MD，-5.0；95% CI，-5.70 至 -4.39；p < 0.001）。总体而言，与纱布相比，所有类型的敷料和 NPWT 在增加轻微或严重伤口并发症（包括浅表和深度感染）方面都没有统计学意义上的显著风险：结论：尽管各种切口敷料和 NPWT 与纱布相比，伤口并发症和感染风险之间没有关联，但从统计学角度来看，藻酸盐、水纤维和银水纤维敷料的术后平均变化较小。今后还需要进行研究，以评估这些敷料是否能降低感染风险：有关证据等级的完整描述，请参阅 "作者须知"。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.