Closed-Incision Negative Pressure Wound Dressing Improves Outcomes in Obese Aseptic Revision Total Hip and Knee Arthroplasty.

Abstract

Background: The burden of revision total joint arthroplasty (rTJA) is increasing. Revision procedures are associated with an increased risk of perioperative complications. Obese patients undergoing rTJA may have a higher risk of wound complications due to their soft-tissue envelope. Closed-incision negative pressure wound therapy (ciNPWT) has been rigorously investigated for its effect on reducing wound complications, however, the literature is limited to primary total joint arthroplasty. The purpose of the current study was to investigate the association between ciNPWT and clinical outcomes for obese patients undergoing aseptic revision total hip and knee arthroplasty.

Methods: This was a retrospective study examining aseptic rTJA procedures from January 2017 to December 2021 at a high-volume institution. Patients were included if their body mass index (BMI) was > 35 and had a minimum follow-up of two years. The cohorts were rTJA procedures that used ciNPWT versus procedures without ciNPWT use. A total of 214 rTJA (Hip, n = 61; Knee, n = 153) patients qualified for analysis. After surgery, ciNPWT was applied on 130 (60.7%) patients (92 knees, 38 hips), and standard dressing was used on 84 (39.3%) patients (61 knees, 23 hips). There were no significant baseline differences between the groups. Outcomes evaluated were: (1) revision for infection; (2) superficial wound complications; (3) overall complications; (4) all-cause revision; and (5) all-cause readmissions. The association between ciNPWT use and outcomes was evaluated using Chi-square tests.

Results: When controlling for all variables, ciNPWT use was associated with significantly fewer revisions for infection (0.8 versus 8.3%), overall complications (3.8 versus 11.9%), all-cause revisions (3.1 versus 13.1%), and readmissions (10.8 versus 21.7%) compared to those who did not use ciNPWT. Secondary superficial wound complication-specific outcomes did not show significant differences.

Conclusion: To our knowledge, this study is the largest retrospective study to date examining the effect of ciNPWT on outcomes in obese aseptic revision rTJA patients. Our results demonstrated major benefits associated with the use of ciNPWT in obese patients undergoing aseptic rTJA in reference to infection-related revision, overall complications, all-cause revisions, and early readmission for any reason.