Abstract
ABSTRACTObjectiveTo present our institution's experience with negative-pressure wound therapy (NPWT) as an adjuvant in wound healing of patients who have undergone revision total hip arthroplasty (THA) due to septic loosening in the presence of active fistula.MethodsWe prospectively assessed patients presenting with THA infection, associated with the presence of fistula, treated with a PICO® device for NPWT, in combination with the standard treatment for prosthesis infection in our institution. Resolution of the infectious process and healing of the surgical wound without complications were considered an initial favorable outcome.ResultsWe assessed 10 patients who used PICO® in our department. No complications were identified in association with the use of the NPWT device. The mean follow-up of the patients after use of the device was 12.7 months. Only one patient progressed with fistula reactivation and recurrence of infection.ConclusionNPWT can be used in wound complications and infection following THA procedures safely and with promising results. Randomized prospective studies should be conducted to confirm its effectiveness. Level of Evidence IV, Case Series.
Highlights
Total hip arthroplasty (THA) is the standard of care for cases of primary or secondary osteoarthrosis in which conservative treatment has failed
Ten patients diagnosed as having septic loosening with an active fistula underwent a two-stage total hip arthroplasty (THA) revision, and PICO was used in the second revision when the implants were placed
Two patients used the device for 21 days, one with rheumatoid arthritis and the other a smoker
Summary
Total hip arthroplasty (THA) is the standard of care for cases of primary or secondary osteoarthrosis in which conservative treatment has failed. With the increase in the number of arthroplasties and the number of young and old patients with more comorbidities, the number of revision surgeries and complications of this procedure have increased, including surgical wound complications and infections. Known risk factors for skin complications and postoperative infection after THA include rheumatological diseases, diabetes, obesity, poor nutrition, smoking, and previous surgeries.[1] Some of the measures recommended in the literature to decrease the risk of infection after THA include the use of prophylactic antibiotics before the incision, shaving with a trichotomizer and not with a blade, adequate sanitazation of the hands and forearms, a strictly sterile technique, preparation of the skin with an alcohol solution, control of comorbidities such as diabetes and malnutrition in the perioperative
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