Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties
Identifieur interne : 000F72 ( Main/Exploration ); précédent : 000F71; suivant : 000F73Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties
Auteurs : S. L. Karlakki [Royaume-Uni] ; A. K. Hamad [Royaume-Uni] ; C. Whittall [Royaume-Uni] ; N. M. Graham [Royaume-Uni] ; R. D. Banerjee [Royaume-Uni] ; J. H. Kuiper [Royaume-Uni]Source :
- Bone & Joint Research [ 2046-3758 ] ; 2016.
Abstract
Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties.
A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group.
An improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06).
Based on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.
Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial.
Url:
DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1
PubMed: 27496913
PubMed Central: 5013893
Affiliations:
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L." last="Karlakki">S. L. Karlakki</name><affiliation wicri:level="1"><nlm:aff id="aff1-2046-3758.58.BJR-2016-0022.R1">Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG</wicri:regionArea><wicri:noRegion>SY10 7AG</wicri:noRegion></affiliation></author><author><name sortKey="Hamad, A K" sort="Hamad, A K" uniqKey="Hamad A" first="A. K." last="Hamad">A. K. Hamad</name><affiliation wicri:level="1"><nlm:aff id="aff1-2046-3758.58.BJR-2016-0022.R1">Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG</wicri:regionArea><wicri:noRegion>SY10 7AG</wicri:noRegion></affiliation></author><author><name sortKey="Whittall, C" sort="Whittall, C" uniqKey="Whittall C" first="C." last="Whittall">C. Whittall</name><affiliation wicri:level="1"><nlm:aff id="aff1-2046-3758.58.BJR-2016-0022.R1">Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG</wicri:regionArea><wicri:noRegion>SY10 7AG</wicri:noRegion></affiliation></author><author><name sortKey="Graham, N M" sort="Graham, N M" uniqKey="Graham N" first="N. M." last="Graham">N. M. Graham</name><affiliation wicri:level="1"><nlm:aff id="aff1-2046-3758.58.BJR-2016-0022.R1">Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG</wicri:regionArea><wicri:noRegion>SY10 7AG</wicri:noRegion></affiliation></author><author><name sortKey="Banerjee, R D" sort="Banerjee, R D" uniqKey="Banerjee R" first="R. D." last="Banerjee">R. D. Banerjee</name><affiliation wicri:level="1"><nlm:aff id="aff1-2046-3758.58.BJR-2016-0022.R1">Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG</wicri:regionArea><wicri:noRegion>SY10 7AG</wicri:noRegion></affiliation></author><author><name sortKey="Kuiper, J H" sort="Kuiper, J H" uniqKey="Kuiper J" first="J. H." last="Kuiper">J. H. Kuiper</name><affiliation wicri:level="1"><nlm:aff id="aff1-2046-3758.58.BJR-2016-0022.R1">Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Arthroplasty Department, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS FT, Oswestry, SY10 7AG</wicri:regionArea><wicri:noRegion>SY10 7AG</wicri:noRegion></affiliation></author></analytic><series><title level="j">Bone & Joint Research</title><idno type="eISSN">2046-3758</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="section1-2046-3758.58.BJR-2016-0022.R1"><title>Objectives</title><p>Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties.</p></sec><sec id="section2-2046-3758.58.BJR-2016-0022.R1"><title>Methods</title><p>A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group.</p></sec><sec id="section3-2046-3758.58.BJR-2016-0022.R1"><title>Results</title><p>An improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06).</p></sec><sec id="section4-2046-3758.58.BJR-2016-0022.R1"><title>Conclusions</title><p>Based on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.</p><p>Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. <italic>Bone Joint Res</italic> 2016;5:328–337. 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Sexton</name></author><author><name sortKey="Mann, C" uniqKey="Mann C">C Mann</name></author><author><name sortKey="Donell, S" uniqKey="Donell S">S Donell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Khan, Rj" uniqKey="Khan R">RJ Khan</name></author><author><name sortKey="Fick, D" uniqKey="Fick D">D Fick</name></author><author><name sortKey="Yao, F" uniqKey="Yao F">F Yao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Howell, Rd" uniqKey="Howell R">RD Howell</name></author><author><name sortKey="Hadley, S" uniqKey="Hadley S">S Hadley</name></author><author><name sortKey="Strauss, E" uniqKey="Strauss E">E Strauss</name></author><author><name sortKey="Pelham, Fr" uniqKey="Pelham F">FR Pelham</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Royaume-Uni</li></country></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Karlakki, S L" sort="Karlakki, S L" uniqKey="Karlakki S" first="S. L." last="Karlakki">S. L. Karlakki</name></noRegion><name sortKey="Banerjee, R D" sort="Banerjee, R D" uniqKey="Banerjee R" first="R. D." last="Banerjee">R. D. Banerjee</name><name sortKey="Graham, N M" sort="Graham, N M" uniqKey="Graham N" first="N. M." last="Graham">N. M. Graham</name><name sortKey="Hamad, A K" sort="Hamad, A K" uniqKey="Hamad A" first="A. K." last="Hamad">A. K. Hamad</name><name sortKey="Kuiper, J H" sort="Kuiper, J H" uniqKey="Kuiper J" first="J. H." last="Kuiper">J. H. Kuiper</name><name sortKey="Whittall, C" sort="Whittall, C" uniqKey="Whittall C" first="C." last="Whittall">C. Whittall</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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