Negative Pressure Incisional Therapy and Postoperative Infection after Posterior Approach Primary Total Hip Arthroplasty.

Vineet Tyagi,David Gibson,Patrick Huang,Joseph Kahan,Don Li

doi:10.7759/cureus.7394

Abstract

A major complication after total hip arthroplasty (THA) is infection, which can have devastating clinical and financial results. Silver-impregnated dry dressings, such as Aquacel dressings, and incisional negative pressure dressings (Prevena) have been developed to reduce the rates of surgical site infections (SSIs) after surgery. We retrospectively reviewed the medical records of 235 patients who underwent primary posterior approach THA at our institution during a three-year period. Patients were grouped based on surgical dressing. Rates of SSI were recorded, as well as the effects of factors including age, sex, body mass index, and medical comorbidities. In the high-risk subgroup, defined as BMI > 30 and ASA > 3, the infection rate was 2.97% in the Aquacel group, compared to 1.20% in the Prevena group. This difference did not reach statistical significance. There was a statistically significant impact on readmissions rate (p = 0.028) and reoperation (p = 0.001). The findings of this study suggest that negative pressure dressings in carefully selected patients may help to reduce reoperations and readmissions in this subgroup.

Highlights

Total hip arthroplasty (THA) has been shown to be a successful procedure for degenerative changes of the hip, with over 95% survivorship with 10 years of follow-up [1, 2]
Between January 2016 and January 2019, 235 patients met the inclusion/exclusion criteria of our study and underwent a total of 235 total hip arthroplasties via the posterior approach. iNPWT was used in 92 patients and silver-impregnated occlusive dressing was used in 143 patients
Our findings suggest that the use of incisional NPWT helps to reduce reoperation and readmission rates in high-risk patients after undergoing primary posterior approach THA

Summary

Introduction

Total hip arthroplasty (THA) has been shown to be a successful procedure for degenerative changes of the hip, with over 95% survivorship with 10 years of follow-up [1, 2]. The incident of prosthetic joint infection after primary THA is estimated to be around 1-2% [3,4,5]. Certain medical comorbidities, such as diabetes, rheumatoid arthritis, and obesity, serve as risk factors which predispose patients to infections [6,7,8]. With an aging population in the United States, these risk factors become more common, and as a result, complication rates after THA are expected to increase [9,10,11,12,13,14]

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