title: Negative pressure wound therapy is associated with resolution of incisional drainage in most wounds after hip arthroplasty.
abstract: BACKGROUND
  Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty.
  
  
  OBJECTIVE
  We determined (1) the rate of wound complications related to use of NPWT for persistent incisional drainage after hip arthroplasty; (2) the rate of resolution of incisional drainage using this modality; and (3) risk factors for failure of NPWT for this indication.
  
  
  METHODS
  In a pilot study we identified 109 patients in whom NPWT was used after hip arthroplasty for treating postoperative incisional drainage between April 2006 and April 2010. On average, the NPWT was placed on postoperative Day 3 to 4 (range, 2-9 days) and applied for 2 days (range, 1-10 days). We then determined predictors of subsequent surgery. Patients were followed until failure or a minimum of 1 year (average, 29 months; range, 1-62 months).
  
  
  RESULTS
  Eighty-three patients (76%) had no further surgery and 26 patients (24%) had subsequent surgery: 11 had superficial irrigation and débridement (I&D), 12 had deep I&D with none requiring further surgery, and three ultimately had component removal. Predictors of subsequent surgery included international normalized ratio level greater than 2, greater than one prior hip surgery, and device application greater than 48 hours. There were no wound-related complications associated with NPWT.
  
  
  CONCLUSIONS
  The majority of our patients had cessation of wound drainage with NPWT.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA, 19107, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Hansen
authors.forename: Joel B
authors.initials: JB
authors.lastname: Durinka
authors.forename: James A
authors.initials: JA
authors.lastname: Costanzo
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Deirmengian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D003646:Debridement; D004322:Drainage; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D010865:Pilot Projects; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014945:Wound Healing
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