Postoperative wound management with negative pressure wound therapy in knee and hip surgery: a randomised control trial.

OBJECTIVE: To compare the effectiveness in wound healing of negative pressure wound therapy (NPWT) versus a standard dressing in patients who underwent hip or knee revision surgery.

METHOD: Participating patients scheduled for hip and knee prosthetic revision were randomised into two groups: one receiving standard povidone-iodine gauze and patch wound dressing (control group) and the other NPWT over the sutured wound area (NPWT group). Patients were evaluated by means of ASEPSIS score, occurrence of blisters, visual analogue scale (VAS) and dressing changes seven days after surgery. We hypothesised a five-point difference in ASEPSIS scores as clinically relevant.

RESULTS: A total of 110 patients were enrolled in the study. Mean ASEPSIS score was 5.1 for the control group and 3.0 for the NPWT group, with a significant difference in the ASEPSIS score between groups (p<0.001), although this was not clinically relevant. Considering patients with more than three risk factors for healing complication, a statistical difference of >5 points ASEPSIS score was recorded (p<0.0005). Blister occurrence, VAS score and number of dressing changes were significantly lower in the NPWT group.

CONCLUSION: The results of this study do not support the routine use of NPWT after hip and knee revision. However, it could be beneficial for selected patients once specific risk factors for wound healing complications have been determined.