Treatment of infected metalwork in orthopaedic patients

Abstract

I read with interest the article by Norris et al. The reported results seem encouraging but I find it difficult to understand what this study adds to previous work. The use of ‘conventional’ negative pressure wound therapy (NPWT) dressings for treatment of infected metalwork has been described previously with similar success rates. The technique described here has three deviations from this widely accepted standard: the addition of a novel irrigation system, the substitution of wide pore foam for hydrophilic polyvinyl alcohol foam and the return of the patient to theatre for change of dressing under anaesthesia. It is not clear what advantage is conferred by the addition of these adjuncts to this well established NPWT technique. The irrigation system may, in fact, be disadvantageous to the patient as it necessitates a protracted inpatient stay whereas a conventional NPWT system allows the patient to be treated in the community. The undertaking of regular dressing changes in theatre under general anaesthesia might confer an advantage in that repeat debridements would have been possible while further contamination of the metalwork was avoided. Although the use of the polyvinyl foam has a theoretical advantage of decreased bacterial load, was this borne out in reality? By changing three variables at once without the use of a control group, it is difficult to draw meaningful conclusions from this study, and hence justify the increased cost and inconvenience involved. Nevertheless, it is a promising piece of work and I await with anticipation further research by this group.