Effectiveness of Negative-Pressure Wound Therapy following Total Hip and Knee Replacements

In this review, we assess the effects of negative-pressure wound therapy (NPWT) following primary hip and knee replacement surgery with a systematic review of randomized controlled trials (RCTs). We searched the Cochrane Bone, Joint, and Muscle Trauma Group's Specialized Registry on June 12, 2018; the Cochrane Central Register of Controlled Trials (CENTRAL, 2018, Issue 1); Ovid MEDLINE (1946-2018); and Embase (1980-2018). To identify RCTs, we combined a subject-specific search strategy with a sensitivity-maximizing version of the Cochrane highly sensitive search strategy. Included were RCTs and quasi-RCTs that compare NPWT with other treatments or no treatment following primary hip and knee replacements. We excluded trials that were focused on patients undergoing revision hip or knee replacements or who had pathological bone disease or periprosthetic fractures. Five RCTs met the inclusion criteria and are included in this review, making a total of 382 patients with primary total hip/knee replacements. Included trials were of varying quality, with little consistency in control groups or outcome measures; therefore, a meta-analysis could not be performed. Overall, three RCTs reported no significant differences in primary outcomes after NPWT, in comparison to standard or conventional wound care. One trial reported significant reduction in wound seroma size in patients undergoing primary hip replacements after NPWT, compared to standard dressings (NPWT, 1.97 vs. 5.08 mL [p = 0.021]; n = 19). Finally, one trial that compared NPWT with standard dressings following primary hip/knee replacements (n = 209) reported statistically significant differences that favored NPWT for overall reduction in length of hospital stay (mean difference, 0.9 d, 95% confidence interval [CI], -0.2-2.5; p = 0.07), number of dressing changes (mean difference, 1.7; 95% CI, 0.8-2.5; p = 0.002), and a fourfold reduction in reported postoperative surgical wound complications (8.4% vs. 2.0%; p = 0.06). Cost-effectiveness quality adjusted life years showed greater savings for higher-risk patients (body mass index ≥ 35; ASA ≥ 3). We find no justification for applying NPWT to all postoperative wounds after routine total hip and knee replacement; however, NPWT may benefit selected patients who are at high risk for wound complications.