Two hundred and ninety-four patients who underwent a revision total knee arthroplasty and were at high-risk of surgical site complications were randomized to receive closed-incision negative pressure therapy (n=147) or silver-impregnated antimicrobial dressing (n=147). The primary outcome of interest was 90-day occurrence of surgical site complications. Secondary outcomes of interest included 30-day and 45 day surgical site complication rates, re-admission, number of dressing changes, adverse events, and patient-reported pain, and patient-reported physical and mental health. Closed-incision negative pressure wound therapy provided significantly lower occurrence of 90-day surgical site complications. The number of dressing changes and the rate of readmission was significantly lower in the closed-incision negative pressure wound therapy group. No significant differences in patient reported pain, physical health or mental health were observed between groups at 90 days.