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World J Orthop. Jan 18, 2016; 7(1): 30-37
Published online Jan 18, 2016. doi: 10.5312/wjo.v7.i1.30
Role of negative pressure wound therapy in total hip and knee arthroplasty
Marcelo BP Siqueira, Deepak Ramanathan, Alison K Klika, Carlos A Higuera, Wael K Barsoum
Marcelo BP Siqueira, Deepak Ramanathan, Alison K Klika, Carlos A Higuera, Wael K Barsoum, Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Siqueira MBP and Ramanathan D reviewed the literature for this minireview and wrote the manuscript; Klika AK, Higuera CA and Barsoum WK edited the manuscript.
Conflict-of-interest statement: No financial support was received for this study. One author Carlos A Higuera has received research support funding from Stryker and KCI outside the submitted work; One author Carlos A Higuera lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript; in the amount of USD 100001-USD 1000000 from Stryker and KCI; One author Wael K Barsoum has received research support from grants from Stryker, Zimmer, personal fees from Shukla Medical, personal fees from Wright Medical Technology, personal fees from Exactech, personal fees from KEF Healthcare, other from OtisMed Corporation, other from Custom Orthopaedic Solution, other from iVHR, grants from DJO, grants from Active Implants, grants from The Medicines Company, grants from State of Ohio, grants from Orthovita, grants from CoolSystems, grants from Orthopaedic Research and Education Foundation, grants from Salient Surgical Technologies, outside the submitted work; One author Wael K Barsoum lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript; in the amount of USD 100001-USD 1000000 from the above institutions. None of the other authors have any conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alison K Klika, MS, Research Program Manager, Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, United States. klikaa@ccf.org
Telephone: +1-216-4444954 Fax: +1-216-4456255
Received: May 24, 2015
Peer-review started: May 25, 2015
First decision: August 16, 2015
Revised: October 2, 2015
Accepted: November 17, 2015
Article in press: November 25, 2015
Published online: January 18, 2016
Processing time: 236 Days and 8.7 Hours
Abstract

Negative-pressure wound therapy (NPWT) has been a successful modality of wound management which is in widespread use in several surgical fields. The main mechanisms of action thought to play a role in enhancing wound healing and preventing surgical site infection are macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. Due to the devastating consequences of infection in the setting of joint arthroplasty, there has been some interest in the use of NPWT following total hip arthroplasty and total knee arthroplasty. However, there is still a scarcity of data reporting on the use of NPWT within this field and most studies are limited by small sample sizes, high variability of clinical settings and end-points. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage, and for this reason surgical intervention should not be delayed when indicated. The prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage appears to have the strongest clinical evidence. Several clinical trials including single-use NPWT devices for this purpose are currently in progress and this may soon be incorporated in clinical guidelines as a mean to prevent periprosthetic joint infections.

Keywords: Negative-pressure wound therapy; Vacuum-assisted closure; Total knee replacement; Total hip replacement; Prosthesis-related infections

Core tip: The application of negative pressure wound therapy (NPWT) in arthroplasty has generated much interest. Its proposed mechanisms of action include macrodeformation and microdeformation of the wound bed, fluid removal, and stabilization of the wound environment. There is little evidence to support the use of NPWT as an adjunctive treatment for surgical wound drainage. However, there appears to be strong clinical evidence for the prophylactic use of NPWT after arthroplasty in patients that are at high risk for postoperative wound drainage. Several clinical trials involving single-use NPWT devices for this purpose are currently in progress.