International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty.

INTRODUCTION: This modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures.

MATERIALS AND METHODS: An international panel of 20 orthopaedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were three rounds of anonymous voting per topic using a modified five-point Likert scale with a predetermined consensus threshold of ≥75% agreement necessary for a statement to be accepted.

RESULTS: After three rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included: 1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); 2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); 3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); 4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and 5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures.

CONCLUSIONS: Through a structured modified Delphi approach, a panel of 20 orthopaedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.