Cost of negative pressure wound therapy in TKA not offset by benefit in QoL, satisfaction

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
21 patients scheduled for bilateral total knee arthroplasty had one knee randomized to postoperative management with negative pressure wound therapy, while the other knee was managed with conventional dry dressings. The purpose of this study was to compare cost, the incidence of complications, and measures of quality of life between dressing strategies within 10-12 day follow-up. Results demonstrated significantly Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: Royalties
Why was this study needed now?
Periprosthetic joint infection following total knee arthroplasty is an uncommon but costly complication. Superficial wound infection has been identified as a possible risk factor in the development of periprosthetic joint infection. Accordingly, research has been undertaken investigating various methods to reduce infection risk and improve wound healing, such as with negative pressure wound therapy (NPWT). Nevertheless, the majority of previous trials on its use have been performed in cases of orthopaedic trauma as opposed to elective arthroplasty. This study sought to evaluate the effects of NPWT on the quality of life and associated cost of treatment as compared to conventional dry dressings.
What was the principal research question?
Does negative pressure wound therapy in the postoperative management of total knee arthroplasty patients have any significant beneficial effect on quality of life or cost as compared to conventional dry dressings?
Population: 21 patients (42 knees), 18 years of age or older, scheduled for bilateral total knee arthroplasty. (Mean age: 66 [range: 45-80])
Intervention: Negative pressure wound therapy (NPWT): In one knee, patients received a negative pressure wound therapy device (Prevena Incision Management System, Acelity KCI), set at a pressure of 125mmHg. Devices were to be worn for 8 days postoperatively.
Comparison: Conventional dry dressings (CDD): In the other knee, conventional dry dressings were used over the wound as per surgeon preference, and included standard materials such as dressing packs, gauze, hydrocolloid dressing and transparent vapour permeable dressing, wool, and crepe bandages. Dressings were to be changed in the presence of moderate discharge.
Outcomes: The primary outcomes were the cost of dressings, the incidence of wound complications, and quality of life measures. One measure was a patient diary in which patients scored their satisfaction from 0-5 for "very happy" to "very unhappy" in ten different areas: odor, wound leakage, itch, movement, body image, self-esteem, personal hygiene, wound protection, sleep, and pain. The other measure was a patient questionnaire based on the dressings durability, effect on mobility and exercise, and any pain or odd sensations experienced while wearing the dressings. Secondary outcomes included the incidence of maceration and blistering.
Methods: RCT
Time: Patients were assessed at 10-12 days postoperatively.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.