Indian expert consensus on prophylactic incisional single-use negative pressure wound therapy in hip and knee...

Surgical site complications remain an important cause of morbidity following total hip and knee arthroplasty. While international guidelines support the selective use of prophylactic single-use negative pressure wound therapy (sNPWT) in appropriately selected high-risk patients and surgical incisions, these recommendations are largely derived from studies performed in highly standardized healthcare environments. Differences in patient characteristics, healthcare delivery, perioperative pathways, resource utilization, and postoperative surveillance may influence their applicability across diverse healthcare systems. Consequently, pragmatic, context-specific recommendations are needed to translate the available evidence into routine clinical practice in India and other countries with similar healthcare settings.

A modified Delphi process was conducted involving 10 experienced arthroplasty surgeons from across India. An exploratory meeting identified key clinical questions and developed candidate statements. Subsequently, nine experts independently evaluated 13 statements using anonymous four-point Likert-scale voting. Consensus was predefined as ≥75% agreement.

Twelve of the 13 candidate statements achieved consensus (agreement 77.8%-100%). The expert panel agreed that prophylactic sNPWT may be considered in selected high-risk situations, including revision arthroplasty involving implant removal, prolonged operative time (>120 min), morbid obesity (BMI > 40 kg/m²), uncontrolled diabetes (HbA1c > 8%), and high-tension wounds. Consensus was also achieved on key contraindications and practical application principles. These recommendations represent consensus-informed clinical guidance rather than definitive evidence-based recommendations.

This modified Delphi consensus translates the available evidence and collective expert experience into practical recommendations for the selective use of prophylactic sNPWT following hip and knee arthroplasty. By providing a structured framework for patient selection and application, it aims to support consistent, evidence-informed decision-making in routine clinical practice, particularly in healthcare settings where context-specific implementation of international recommendations is required. Prospective clinical and health economic studies are needed to further validate these recommendations.