During a May webinar hosted by Becker’s Hospital Review and sponsored by ConvaTec, three orthopedic surgeons discussed how they are using negative pressure wound therapy to improve outcomes for total joint replacement patients:
- Daniel Allison, MD, Cedars-Sinai Orthopaedics in Los Angeles
- Matthew Grosso, MD, Advanced Orthopedics New England in Bloomfield, Conn.
- William Long, MD, Hospital for Special Surgery in New York City
Four insights were:
- Periprosthetic joint infection is a persistent problem and the clinical implications are severe. According to Dr. Allison, PJI is the leading cause of morbidity following joint replacement. “Joint infection treatment comes down to four principles: a thorough debriding of all infected and devitalized bone, soft tissue and foreign matter; maintenance of mechanical stability of the area; delivery of the appropriate antibiotic locally and systemically and preservation of the soft tissue envelope,” Dr. Allison explained. Negative pressure wound therapy minimizes local contamination after surgery and optimizes the soft tissue envelope.
- Experts worldwide believe that negative pressure wound therapy is important for high-risk patients. The International Consensus for Prosthetic Joint Infection gathered over 400 experts from approximately 60 countries to review over 3,500 peer-reviewed publications. The group found that negative pressure dressings are beneficial for high-risk patients and a super majority felt they were useful for therapeutic early treatment of wound drainage. “If you have a patient with one risk factor, you might not use this dressing,” Dr. Allison said. “If you have two, three or four risk factors or a revision case, then it becomes a no brainer.”
- When selecting surgical dressings for patients, risk stratification goes deeper than body mass index alone. “When Dr. Ran Schwarzkopf and I looked at the periarticular soft tissue index, as we coined it,” Dr. Long said, “we found a higher risk of complications associated with the thickness of the soft tissue envelope than just BMI alone.” Additional risk criteria that Dr. Grosso considers for primary arthroplasty patients include use of non-aspirin blood thinners, peripheral vascular disease, tobacco usage, history of prior infection at an operative site, insulin-dependent diabetes, current use of immunomodulators or corticosteroids, ongoing malignancy, malnutrition, liver disease and a history of a solid organ transplant. “In any case where I’m concerned about patient risk, I’ve become very proactive about using negative pressure wound therapy,” Dr. Long said.
- In addition to high-risk patients, negative pressure wound therapy is also beneficial for revision joint replacements and postoperative complications. “I use negative pressure wound therapy for about 25 percent of my primary total hip surgeries and I find I have fewer wound healing issues, particularly at the proximal aspect of the incision,” Dr. Grosso said. “I’m concerned about wound healing in anyone with high obesity and a large pannus.” Dr. Grosso also turns to negative pressure wound therapy for 10 percent of his primary knee procedures, for most revisions and postoperatively if a patient is having issues with wound healing.
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