Could intermittent change of conventional dressing affect risk of periprosthetic joint infection after primary total joint arthroplasty?

PURPOSE

Periprosthetic joint infection (PJI) is one of the most dreaded and challenging complications after total joint arthroplasty (TJA). The aim of this study was to evaluate the effect of keeping the dressing without change on the occurrence of PJI in patients undergoing TJA.

METHODS

4877 Patients with a minimum follow-up of 90 days were included to investigate the effect of dressing on the PJI occurring within 3 months of surgery. Patients were divided into two consecutive groups as the intermittent change of traditional dressing (group 1-before 2019) and keeping dressing for 5 days without change (group 2-after 2019). A backward stepwise logistic regression model was used to estimate independent risk factors for PJI.

RESULTS

Group 1 and group 2 consisted of 4172 and 705 patients, and the numbers of diagnosed PJI cases in the groups were 40 (1.0%) and 10 (1.4%), respectively (p = 0.1). The backward stepwise logistic regression model analysis revealed that keeping the dressing unchanged and removing it after the first week postoperatively was not an independent risk factor for the occurrence of PJI. Older age, diabetes mellitus and coronary artery diseases were independent risk factors for PJI (p < 0.05).

CONCLUSION

Our study results present, that intermittent change of conventional dressing is unnecessary, because it does not decrease the risk of PJI after TJA.

LEVEL OF EVIDENCE

Level III Therapeutic.

Wound Dressings for Hip and Knee Total Joint Arthroplasty: A Narrative Review

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Dressing choice following lower-extremity total joint arthroplasty has substantial ramifications for postoperative outcomes and should be carefully made to prevent complications such as periprosthetic joint infection.

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Patient risk factors are essential components in the selection of wound dressings in total joint arthroplasty.

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Traditional dressings are inexpensive per unit; nevertheless, the associated higher complication profile in patients at a high risk for poor wound healing and sequelae-associated costs may outweigh the up-front savings.

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Modern dressings have the potential to yield better safety outcomes and increased patient satisfaction; however, there is a paucity of evidence regarding the ideal interactive dressing.

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Active dressings, such as silver-ion dressings and closed-incisional negative-pressure wound therapy, have shown promising results to reduce surgical site and periprosthetic joint infection, especially in patients at a high risk for poor wound healing following hip and knee total joint arthroplasty.

Choosing the Optimal Wound Dressing for Bathing After Total Knee Arthroplasty

BACKGROUND

Many surgical dressings claim to be waterproof and safe for bathing postoperatively. The purpose of this study is to evaluate and compare the effectiveness of commonly used dressings' ability to prevent water penetration while bathing. Additionally, a survey was used to determine satisfaction and cost analysis performed.

METHODS

Four different dressings were applied to 17 subjects' knees: Aquacel, Opsite, Acticoat, and Tegaderm. A folded Medline Gauze Sponge was weighed and placed under each dressing before and after showering and bathing (submergence under water) in order to measure water penetration (change in weight of sponge in grams). A failure was defined as any dressing that allowed a sponge weight change greater than 1 standard deviation, or 3.9 g. All participants were additionally asked to complete a short survey after testing about the dressings.

RESULTS

Tegaderm was found to have significantly less water penetration than all other dressings except Aquacel and demonstrated no failures with showering, significantly less than all other dressings. Tegaderm was also found to have significantly less water penetration than all other dressings except Acticoat with bathing and had significantly less failures than all other dressings. Furthermore, Tegaderm was found to be the most comfortable and lowest cost per dressing.

CONCLUSION

Tegaderm was overall the most effective at preventing water penetration, most comfortable, and most cost-effective. Aquacel was found to be equally as effective at preventing water penetration while showering but overall had more water penetration, had more failures, caused more discomfort, and was more expensive.

The Effect of a Skin Barrier Film on the Incidence of Dressing-Related Skin Blisters After Spine Surgery

Tension blisters from adhesive dressings may lead to pain and delayed surgical wound healing for surgical patients and cause an institutional cost burden. Commercial skin barrier film products may reduce dressing-related postoperative skin blistering in surgical patients. Project investigators at an orthopedic specialty hospital randomized 185 surgical spine patients to receive either a standard wound dressing (ie, control group) or a dressing with the addition of a skin barrier film applied beneath it (eg, treatment group). During the first postoperative dressing change, the participants' skin was assessed for redness, soreness, blistering, or tearing. Approximately 15% of participants in the treatment group and 15% of participants in the control group developed a postoperative skin injury (P = .98). Multivariable analyses did not indicate the skin barrier film provided a protective effect. Additionally, there was no association between patient-specific characteristics and skin blisters among the participants. These results do not support the use of a skin barrier film in surgical spine patients.

Predictive factors for the formation of tape blisters: An observational, prognostic prospective study

BACKGROUND

Tape blisters are common complications in the peri-lesional area of the surgical incision, forming below the layer of dressing adhesive applied and causing numerous complications for patients.

OBJECTIVES

The purpose of this study was to investigate the incidence of the phenomenon, and to identify and quantify the main prognostic factors associated.

DESIGN

Multicentric, prognostic prospective cohort study.

SETTING

Shoulder Orthopaedic surgery, General surgery, Advanced Oncology therapies, Gastro-entero mininvasive surgery and Endocrine surgery.

PARTICIPANTS

One thousand and two patients who underwent chest, abdominal, upper limb and joint laparotomic surgery consecutively admitted to the surgical units involved, were included.

METHODS

Data regarding individual and patient care variables, such as intrinsic (e.g. age and gender) and extrinsic (e.g. surgery type and time) data were collected. A multivariate logistic regression model was used to identify the variables which independently influenced the onset of the tape blister.

RESULTS

In the multivariate analysis, patients who underwent chest (Odds Ratio = 8.99, 95% CI 5.33-15.13), and upper limb and joint surgery (Odds Ratio = 2.09, 95% CI 1.22-3.58) were more likely to develop tape blisters in the postoperative period, At the same time, having drainage (Odds Ratio = 1.98, 95% CI 1.11-3.53), being female (Odds Ratio = 1.56, 95% CI 1.01-2.44) and having a high Body Mass Index (BMI) score (Odds Ratio: 1.06, 95% CI 1.02-1.11) were also predictors of tape blister formation.

CONCLUSIONS

A higher BMI score, chest, upper limb and joint surgery, female gender and the presence of drainage were predictive factors of the tape blister event while, in contrast with the literature, the type of dressing used in this study was not significantly associated with the event.

The effect of wound dressings on infection following total joint arthroplasty

Background

The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA.

Methods

MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA. All studies comparing Hydrofibre dressings to Standard dressings or Absorbent dressings were included in this meta-analysis. Studies looking at TJA secondary to trauma were excluded. Two individuals independently extracted data, and study results were divided based on type of treatment. The primary outcome was to compare the infection rate of Hydrofibre dressings to that of both Standard Dressings and Absorbent dressings.

Results

Of a total of 3721 participants, 1483 were treated with Standard dressings (non-impregnated gauze), 1911 with Hydrofibre dressings, and 327 with Absorbent dressings. The risk ratio for infection comparing Standard with Hydrofibre was 4.16 (95% confidence interval, 1.71-10.16) as compared to 2.60 (95% confidence interval, 0.66-10.27) when comparing Absorbent with Hydrofibre dressings.

Conclusions

Our analysis suggests that Hydrofibre dressings may be significantly better than Standard and Absorbent dressings with respect to reducing infection. However, given the observed heterogeneity and small number of studies included, more comparative studies are needed to definitively recommend superiority among dressings following TJA.

Level of Evidence

Level 1.

Changing practice for hip arthroplasty and its implications

This overview provides insight into changes in clinical practice and the implications for nursing staff and clinicians who are involved in the management of patients undergoing primary total hip arthroplasty. The review highlights commonly used surgical approaches, their advantages, their associated risks and how to manage complications if they occur.

Wound dressings for primary and revision total joint arthroplasty

BACKGROUND

Preventing post-surgical complications after total joint arthroplasty (TJA) is of great importance, and application of an appropriate wound dressing is necessary. Since no dressing encompasses all the parameters required for ideal wound healing, a comparison of the available dressing types can assist the surgeon to choose the best dressing after TJA.

METHODS

Studies evaluating postoperative wound dressings after TJA were reviewed in order to assess the outcomes, complications and costs associated with dressing types.

RESULTS

Traditional cotton dressings have a high ability to absorb exudate. However, they dry out sooner and there is a risk of pain and additional trauma during dressing changes. Although vapor permeable dressings allow transmission of moisture, but they have low absorptive capacity and require frequent changes even with moderately exudating wounds. On the other hand, hydrofiber and hydrocolloid dressings have high absorptive capacity and permeability, and can cope with exudate production. They are changed less often and have low blistering rates, which may reduce surgical site infection (SSI). Although the unit cost associated with advanced dressings is much higher than the traditional dressings, the decreased rate of periprosthetic joint infection (PJI) and the cost associated with treating PJI more than compensate for it.

CONCLUSIONS

Choice of dressing type after TJA should depend upon permeability, absorptive capacity, documented rate of SSI and cost effectiveness with its use, apart from a surgeon's past clinical experience and familiarity.

Changes in dimensions of total knee arthroplasty anterior knee dressings during flexion: Preliminary findings

INTRODUCTION

Wound care is critical to the management of patients post total knee arthroplasty, requiring prudent selection of dressings that can accommodate changes in wound length during knee flexion. This study aims to quantify differences in dressing dimensions based on the position of the knee during the application of the dressing and subsequent flexion.

METHODS

Our study involved 40 knees divided into 2 groups, an extension group and a flexion group, each consisting of 20 knees. These groups had dressings applied to the knee in full extension and in 90° of flexion respectively. Measurements of the dressings were taken for the extension group with the knee in extension and for both groups at 90° of flexion.

RESULTS

For the extension group, the changes in length and breadth of the dressings when measured in 90° of flexion were 3.42 ± 0.15 cm, p < 0.001 and -0.43 ± 0.10 cm, p < 0.001 respectively. Compared to the flexion group, the differences in length and breadth between the dressings when measured in 90° of flexion were 3.48 ± 0.15 cm, p < 0.001 and -0.14 ± 0.12 cm, p < 0.001 respectively.

CONCLUSION

There are significant differences and changes in the dimensions of knee dressings depending on the position of the knee during the application of dressing and subsequent flexion.

Achieving international consensus for the prevention of orthopaedic wound blistering: results of a Delphi survey

This article presents the results of an international 2 stage Delphi survey carried out via e-mail to achieve consensus as to the most effective postoperative wound management to prevent blistering and other complications. Seventeen prospective participants were invited to be members of the Delphi Panel of which 13 agreed to be involved. The panel suggested that an ideal wound dressing would conform easily to the wound, be easy to apply and remove, allow for swelling and minimise pain on removal. Participants were in agreement that the primary wound dressing should be left in situ for as long as possible, providing there was no excessive oozing or signs of infection. The authors recognise that the Delphi Panel was relatively compact; however, the study arguably provides some useful data that can be used to identify the consequences of wound blistering and important factors that need to be considered when choosing a wound dressing to prevent blistering.

Wound closure

In this paper, we consider wound healing after total knee arthroplasty.