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Comparison of silver-embedded occlusive dressings and negative pressure wound therapy following total joint arthroplasty in high BMI patients: a randomized controlled trial

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 12 November 2022

A Correction to this article was published on 17 July 2022

This article has been updated

Abstract

Introduction

High body mass index (BMI) and wound drainage following total joint arthroplasty (TJA) can lead to wound healing complications and periprosthetic joint infection. Silver-embedded occlusive dressings and negative pressure wound therapy (NPWT) have been shown to reduce these complications. The purpose of this prospective trial was to compare the effect of silver-embedded dressings and NPWT on wound complications in patients with BMI ≥ 35 m/kg2 undergoing TJA.

Methods

We conducted a randomized control trial of patients who had a BMI > 35 m/kg2 and were undergoing primary TJA between October 2017 and February 2020. Patients who underwent revision surgery, or those with an active infection, previous scar, history of wound healing complications, post-traumatic degenerative joint disease with hardware, or inflammatory arthritis were excluded. Patients were randomized to receive either a silver-embedded occlusive dressing (control) or NPWT. Frequency distributions, means, and standard deviations were used to describe patient demographics, postoperative complications, 90-day readmissions, and reoperations. T-test and chi-squared tests were used to test for significant differences between continuous and categorical variables, respectively.

Results

Two hundred-thirty patients with 3-month follow-up were included. One-hundred-fifteen patients received the control and 115 patients received NPWT. There were six patients (5.2%) in the control group with wound complications (drainage: n = 5, non-healing wound: n = 1) and two patients (1.7%) in the NPWT with complications (drainage: n = 2). There were no 90-day readmissions in the control group versus two (1.8%) 90-day readmissions in the NPWT group. Finally, three patients (2.6%) in the control group underwent reoperations (irrigation and debridement [I&D], I&D with modular implant exchange, and implant revision), while none in the NPWT group had undergone reoperation. The two groups showed insignificant differences in wound complications (p = 0.28), 90-day readmissions (p = 0.50), and reoperations (p = 0.25).

Conclusion

Patients with BMI ≥ 35 m/kg2 undergoing TJA have no statistical difference in early wound complications, readmissions, or reoperations when treated with either silver-embedded dressings or NPWT.

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Huntington Hospital, Zucker School of Medicine Hofstra/Northwell, 270 Park Ave, Huntington, NY, 11743, USA

    Katherine A. Lygrisse

  2. Department of Orthopedic Surgery, Hospital for Special Surgeries, 541 East 71st St, 7th Fl, New York, NY, 10021, USA

    Greg Teo & Long William

  3. Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA

    Vivek Singh, Nishanth Muthusamy & Ran Schwarzkopf

  4. Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Health, 301, East 17th Street, New York, NY, 10003, USA

    Nishanth Muthusamy

Authors
  1. Katherine A. Lygrisse
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  2. Greg Teo
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  4. Nishanth Muthusamy
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  6. Long William
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Corresponding author

Correspondence to Nishanth Muthusamy.

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Conflict of interest

Authors 1, 2, 3, and 4 have no conflict of interests to disclose. Author 5 owns stock or stock options in Intellijoint, Gauss surgical, and PSI. Author 5 is a paid consultant for Smith & Nephew and Intellijoint. Author 5 is also on the editorial/governing board for the Journal of Arthroplasty and Arthroplasty Today and is a board member for AAOS and AAHKS. Author 6 is a paid consultant/speaker for Convatec, DePuy, Pacira, Think Surgical, and TJO. Author 6 has received royalties from Elsevier and OrthoDevelopment. Author 6 is also on the editorial/governing board of the Journal of Arthroplasty and is a board member for AAOS.

Ethical approval

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of NYU School of Medicine (study number: i17-00496_CR2).

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All subjects gave their informed consent for inclusion before they participated in the study.

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Lygrisse, K.A., Teo, G., Singh, V. et al. Comparison of silver-embedded occlusive dressings and negative pressure wound therapy following total joint arthroplasty in high BMI patients: a randomized controlled trial. Arch Orthop Trauma Surg 143, 2989–2995 (2023). https://doi.org/10.1007/s00402-022-04530-1

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  • DOI: https://doi.org/10.1007/s00402-022-04530-1

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