Clinical and Health-Care Cost Analysis of Negative Pressure Dressing in Primary and RevisionTotal Knee Arthroplasty: A Systematic Review and Meta-Analysis

• Published in: Journal of bone and joint surgery. American volume 2020-12, Vol.Publish Ahead of Print, p.541-548
• Main Authors: Yaghmour, Khaled M, Hossain, Fahad Siddique, Konan, Sujith
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - economics; Arthroplasty, Replacement, Knee - statistics & numerical data; Bandages - economics; Cost Savings - statistics & numerical data; Cost-Benefit Analysis - statistics & numerical data; Feasibility Studies; Health Care Costs - statistics & numerical data; Humans; Negative-Pressure Wound Therapy - economics; Negative-Pressure Wound Therapy - methods; Quality-Adjusted Life Years; Reoperation - adverse effects; Reoperation - economics; Reoperation - statistics & numerical data; Surgical Wound Dehiscence - economics; Surgical Wound Dehiscence - epidemiology; Surgical Wound Dehiscence - etiology; Surgical Wound Dehiscence - prevention & control; Surgical Wound Infection - economics; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Treatment Outcome; Wound Healing
• ISSN: 1535-1386
• DOI: 10.2106/JBJS.20.01254

Negative pressure wound therapy (NPWT) has been used because of its perceived advantages in reducing surgical site infections, wound complications, and the need for further surgery. The purpose of this study was to assess the infection rates, wound complications, length of stay, and financial burden associated with NPWT use in primary and revision total knee arthroplasty (TKA). We performed a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic review of the existing literature on using NPWT in primary and revision TKA. PubMed, Embase, Science Direct, and the Cochrane Library were utilized. The risk of bias was evaluated using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool, and the quality of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Twelve articles that evaluated 1,403 primary TKAs and 279 revision TKAs were reviewed. NPWT significantly reduced complication rates in revision TKA. However, there was no significant difference in infection rates between NPWT and regular dressings in primary or revision TKA. NPWT use in primary TKA significantly increased the risk of blistering, although no increase in reoperations was noted. The analysis showed a possible reduction in length of stay associated with NPWT use for both primary and revision TKA, with overall health-care cost savings. Based on a meta-analysis of the existing literature, we do not recommend the routine use of NPWT. However, in high-risk revision TKA and selected primary TKA cases, NPWT reduced wound complications and may have health-care cost savings. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.