Role of negative pressure wound therapy in total hip and knee arthroplasty

Table 1 Literature on negative pressure wound therapy on hip and knee arthroplasty

Ref.	Origin	Type	Indication	Device, negative pressure delivery	Length of use	Results	Conflict of Interest
Gomoll et al[50]	United States	Case series	Revision THA with history of multiple revisions (n = 1 NPWT), hemiarthroplasty with bladder/bowel incontinence (n = 1 NPWT)	V.A.C.®, 75 mmHg	3 d (average)	Incisions noted to be well healed at a minimum of 3 mo	No
Kirr et al[51]	Germany	Case series	I and D for acute hip (n = 3 NPWT) and knee PJI (n = 2 NPWT)	V.A.C.® instill system with antibiotic instillation, amount of pressure delivery N/A	15.2 d (average)	Eradication of infection in all cases, complete wound healing achieved in 10-14 d	N/A
Lehner et al[52]	Germany	Case series	I and D for acute hip (n = 2 NPWT), and knee PJI (n = 1 NPWT)	V.A.C.® instill system with antiseptic solution, 100-150 mmHg	6 d (average)	Retention of all 3 implants with no further signs of infection at a minimum of 8 wk	N/A
Kelm et al[53]	Germany	Case series	I and D for acute hip PJI (n = 28 NPWT)	Periprosthetic placement of V.A.C.®, 200 mmHg for 72 h, and 150 mmHg	6 d	Infection eradication in 26/28 cases with implant retention at a minimum of 12 mo	No
Howell et al[54]	United States	RCT	Primary TKA with increased risk for postoperative drainage (n = 24 NPWT vs n = 36)	V.A.C.®, 125 mmHg	2 d	No difference in days to dry wound; 1 PJI in each group. Study stopped because of skin blisters in 63% of patients in NPWT arm	Yes
Pachowsky et al[55]	Germany	RCT	Primary THA for OA (n = 9 NPWT vs n = 10)	Prevena™, 125 mmHg	5 d	Decreased seroma development in NPWT group (P = 0.021)	Yes
Hansen et al[56]	United States	Retrospective cohort	Persistent wound drainage at POD 3 to 4 after primary THA (n = 86 NPWT) and revision THA (n = 23 NPWT)	V.A.C.®, 125 mmHg	24-48 h	83 (76%) had no further surgery, 26 (24%) had further surgery. No NPWT-related complications	No
Pauser et al[57]	Germany	RCT	Hemiarthroplasty after femoral neck fracture (n = 11 NPWT vs n = 10)	Prevena™, 125 mmHg	5 d	NPWT group had fewer dressing changes, less days of wound secretion, less wound care time, and less dressing material used (P < 0.05 for all)	Yes

V.A.C.^®: Vacuum assisted closure system (KCI, San Antonio, TX); Prevena™: Prevena incision management system (KCI, San Antonio, TX). THA: Total hip arthroplasty; TKA: Total knee arthroplasty; NPWT: Negative pressure wound therapy; PJI: Periprosthetic joint infection; I and D: Incision and debridement; RCT: Randomized controlled trial; OA: Osteoarthritis; N/A: Not available; KCI: Kinetic Concepts Inc.; POD: Post-operative day.