Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer.

Mark A. Snyder,Andrew Hogan,George W.J. Wright,Brian P. Chen

doi:10.1016/j.artd.2021.05.015

Abstract

BackgroundWound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events.MethodsA systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity.ResultsForty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates.ConclusionsConsiderable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses.Level of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Highlights

Introduction and backgroundWound closure is a key, and often underrecognized, component of hip and knee arthroplasty [1,2]
The objective of this study was to conduct a qualitative systematic review of wound closure for hip and knee arthroplasties that characterize the various types of wound closure methods and dressings used in practice, which wound closure methods are used within different tissue layers, and reported rates of adverse events related to wound closure
Of the 68 full-text articles assessed for inclusion, 40 publications were included in the qualitative systematic review (Fig. 1)

Summary

Introduction

Introduction and backgroundWound closure is a key, and often underrecognized, component of hip and knee arthroplasty [1,2]. In CDC guidelines, the reported cost of SSIs range from $10,443 (2005 US dollars [USD]) to $25,546 (2002 USD) per infection [8] Within arthroplasty procedures, another classification of infections includes periprosthetic joint infections (PJIs), defined as infections involving the joint prosthesis and adjacent tissue [9]. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events. Methods: A systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). See Instructions for Authors for a complete description of levels of evidence.

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