Use of Negative-Pressure Wound Dressings to Prevent Surgical Site Complications After Primary Hip Arthroplasty: A Pilot RCT.
OBJECTIVE
Negative-pressure wound therapy (NPWT) is increasingly used for primary surgical incisions despite the paucity of evidence. Study objectives were to assess the use of NPWT on surgical sites to prevent infections and other wound complications after elective primary hip arthroplasty and to consider feasibility of a larger trial.


METHODS
A nonmasked, randomized controlled pilot trial. Patients were recruited preoperatively from the preadmission clinic of an Australian hospital during 2013-2014. Computer-generated randomization was performed with allocation concealed until completion of surgery. The intervention group received NPWT (PICO) while the control group received the standard care hydrocolloid, reinforced with 2 absorbent dressings. Patients were followed for 6 weeks for postoperative complications (infection, length of stay, readmission) and skin complications (bruising, seroma, hematoma, dehiscence). Feasibility end points included numbers recruited, randomized, and followed up; fidelity; and costs.


RESULTS
Of 77 people approached, 76 were recruited, and 70 were randomized. Of 35 in the negative-pressure group, 2 received the standard dressing. Attrition at 6 weeks exceeded 10% in both groups. Dressing costs were lower in the control group ($3.01/d vs $38.40/d); SSI incidence was 2/35 in the NPWT and 3/35 in the control group (intention to treat: risk ratio [RR] = 0.67; 95% confidence interval [CI] = 0.12-3.7; P = .65). NPWT patients experienced more postoperative wound complications (RR = 1.6; 95% CI = 1.0-2.5; P = .04).


CONCLUSIONS
A reduction of 3% in SSI incidence suggests that a definitive trial requires approximately 900 patients per group. Yet there is uncertainty around the benefit of NPWT after elective hip arthroplasty.
Griffith University, Gold Coast, Queensland, Australia b.gillespie@griffith.edu.au.
Brigid M
BM
Gillespie
Griffith University, Gold Coast, Queensland, Australia.
Claire M
CM
Rickard
Kuwait University, Safat, Kuwait.
Lukman
L
Thalib
Griffith University, Gold Coast, Queensland, Australia.
Evelyn
E
Kang
Gold Coast University Hospital, Queensland, Australia.
Tracey
T
Finigan
Gold Coast University Hospital, Queensland, Australia.
Allison
A
Homer
Gold Coast University Hospital, Queensland, Australia.
Gordon
G
Lonie
Gold Coast University Hospital, Queensland, Australia.
Don
D
Pitchford
Griffith University, Gold Coast, Queensland, Australia.
Wendy
W
Chaboyer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001458:Bandages; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation*; D010865:Pilot Projects; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
complications; feasibility; hip replacement; infection; orthopedic; vacuum dressing