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Woelfle CA, Shah RP, Neuwirth AL, Herndon CL, Levine WN, Cooper HJ. 2-Octyl-Cyanoacrylate Mesh Dressings for Total Joint Arthroplasty: Dressing Design Influences Risks of Wound Complications. J Arthroplasty 2024:S0883-5403(24)00650-8. [PMID: 38914145 DOI: 10.1016/j.arth.2024.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty (TJA). Chemical accelerators are typically included to promote the rapid polymerization of 2-octyl cyanoacrylate. The goal of the study is to distinguish designs and wound complication differences between two similar systems. METHODOLOGY An eighteen-week retrospective study was conducted from July to December 2023, including 207 total hip arthroplasty (THA) and 212 total knee arthroplasty (TKA) cases from four attending surgeons at one institution that used one of two dressing designs. Both dressings had a 2-octyl cyanoacrylate liquid adhesive formula that applied topically to a polyester-based mesh overlaying the wound. Mesh A (used in 274 cases) included an accelerator, a quaternary ammonium salt, on the mesh patch, whereas Mesh B (used in 145 cases) included a similar accelerator within the adhesive applicator. RESULTS Wound complications (3.2 versus 7.6%; X2 = 3.86; df = 1; P = 0.049), early periprosthetic joint infections (PJI) (0 versus 2.8%; X2 = 7.63; df = 1; P = 0.006), and 90-day reoperations for wound complications (0.4 versus 3.4%; X2 = 6.39; df = 1; P = 0.011) were significantly lower in patients who received Mesh A versus B, respectively. There was no difference in superficial surgical site infections (SSI) (0.7 versus 0%; X2 = 1.06; df = 1; P = 0.302) or allergy rates (3.3 versus 4.1%; X2 = 0.12; df = 1; P = 0.655) between Mesh A and B. CONCLUSION We observed significantly different performance in wound complications, early postoperative PJI, and 90-day reoperation between the two designs. Having the accelerator in the applicator rather than on the mesh patch, may lead to premature polymerization before bonding appropriately with the mesh to create the desired wound closure and seal.
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Affiliation(s)
- Catelyn A Woelfle
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
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Chen Z, Bains SS, Sax OC, Sodhi N, Mont MA. Optimal Method of Skin Wound Management for Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Knee Surg 2024; 37:238-247. [PMID: 37084759 DOI: 10.1055/s-0043-1768248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Skin closure for total knee arthroplasty (TKA) typically focuses on promoting optimal healing, while preventing wound complications and infection, allowing for functionality and immediate ambulation, and providing for excellent cosmesis. In this systematic review and meta-analysis of the literature, we will focus on closure of the skin. Specifically, we assessed: (1) wound complication risk of different techniques and (2) closing time of different sutures/techniques. There were 20 reports on infection risk and closing time. Meta-analyses focused on the qualifying studies for closing time and wound complication risk reports were also performed. These studies (378 patients) demonstrated overall lower wound complication risks with the use of barbed compared with traditional sutures (3% vs. 6%, p < 0.05). The subsequent meta-analysis included 749 patients demonstrating overall significant closing time reductions of a mean of 7 minutes with the use of barbed sutures (p < 0.05). Therefore, multiple recent reports suggest superior outcomes and faster results when using barbed sutures for TKA skin closure.
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Affiliation(s)
- Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, North Shore University Hospital Northwell Health, New York, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Lei P, Zhong D, Wu H, Gao F, Qi J, Li Z, Lai L, Su S. A New Dressing System for Wound in Enhanced-Recovery Total Hip Arthroplasty: A Randomized and Controlled Trial. J Arthroplasty 2023:S0883-5403(23)00136-5. [PMID: 36805119 DOI: 10.1016/j.arth.2023.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Currently, there is a paucity of recommendations in regards to dressing selection within the enhanced recovery after surgery protocol. We devised a new dressing system to accelerate the recovery after total hip arthroplasty (THA). We aimed to present our experience with this new dressing system as an adjunct to wound management in THA and to evaluate its performance. METHODS From September 2020 to August 2021, we prospectively enrolled 124 patients who underwent a primary THA. The patients were randomly assigned to the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. The primary outcome measures of this study were numbers of dressing changes, postoperative lengths of stay, wound scores including the Stony Brook Scar Evaluation Scale and ASEPSIS scores and wound-related complications. The secondary outcomes include satisfaction scores, dressing-related costs, and pain and functional recovery scores. RESULTS The intervention group numbers of dressing changes and postoperative lengths of stay were significantly less than the control group (P < .001, P < .001). During the one-month follow-up, the Stony Brook Scar Evaluation Scale in the intervention group was significantly better than that in the control group (P < .001). The intervention group satisfaction was significantly higher than that in the control group (P < .001). There were no statistically significant differences between the two groups in terms of dressing-related costs and pain and function scores. CONCLUSION The new dressing system could significantly reduce the number of dressing changes and postoperative lengths of stay and increase patient satisfaction scores, which can be an ideal adjunct to wound management in enhanced-recovery THA.
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Affiliation(s)
- Pengfei Lei
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Honghao Wu
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Fawei Gao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jun Qi
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Zhigang Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Lili Lai
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shilong Su
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China; Department of Orthopedics, Peking University Third Hospital, Beijing, China
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Su S, He J, Wang C, Gao F, Zhong D, Lei P. A New Dressing System Reduces the Number of Dressing Changes in the Primary Total Knee Arthroplasty: A Randomized Controlled Trial. Front Surg 2022; 9:800850. [PMID: 35592127 PMCID: PMC9110771 DOI: 10.3389/fsurg.2022.800850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 03/28/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose We devised a novel dressing system to accelerate the recovery after total knee arthroplasty (TKA). The purpose of this study was to assess the clinical outcomes and economic expenses of the new dressing system. Methods In this randomized and controlled trial, we enrolled 98 patients who underwent the first unilateral TKA between September 2020 and June 2021. The patients were randomly assigned to one of two groups: the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. We gathered and evaluated patient data including age, gender, body mass index, surgical side, number of dressing changes, post-operative hospital stay, dressing-related expense, satisfaction, pain and function scores, wound scores and wound-related complications. Results The number of dressing changes and post-operative hospital stay in the intervention group were significantly less than in the control group (p = 0.000, p = 0.002). Satisfaction in the intervention group was significantly higher than in the control group's (p = 0.000). There were no significant differences between the two groups in dressing-related expense, pain and function scores. During the one month follow-up, the intervention group's Stony Brook Scar Evaluation Scale (SBSES) was considerably higher than the control group's (p = 0.012). Conclusion The new dressing system can reduce the number of dressing changes and post-operative hospital stays while increasing patient satisfaction with no difference in medical costs in TKA. This wound dressing system has potential for application in TKA. Clinical Trial Registration https://clinicaltrials.gov, identifier ChiCTR2000033814.
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Affiliation(s)
- Shilong Su
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedics, The First Hospital of Changsha, Changsha, China
| | - Juan He
- College of Stomatology, Changsha Medical University, Changsha, China
| | - Chenggong Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Fawei Gao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratary of Aging Biology, Xiangya Hospital, Central South University, Changsha, China
| | - Pengfei Lei
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Hunan Engineering Research Center of Biomedical Metal and Ceramic Implants, Xiangya Hospital, Central South University, Changsha, China
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Raja BS, Choudhury AK, Paul S, Gowda AKS, Kalia RB. No Additional Benefits of Tissue Adhesives for Skin Closure in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Arthroplasty 2022; 37:186-202. [PMID: 34419313 DOI: 10.1016/j.arth.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/07/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This systematic review is aimed to compare the performance of tissue adhesives (TA) as an adjunct or closure method with traditional wound closure methods for cutaneous closure in arthroplasty and evaluate whether they have any added benefits in terms of decreasing wound complications and increasing postoperative patient satisfaction. METHODS Cochrane Library, PubMed, and EMBASE were searched until February 2021. Randomized controlled trials (RCTs) comparing outcomes of TA with emphasis on skin closure time, in-hospital stay, complication rates, cosmetic scoring systems, and patient satisfaction scores (PSS) compared to subcuticular sutures (SCS) and skin staples (ST) in arthroplasty. The quality of RCTs was assessed using the National Institutes of Health quality assessment tool. RESULTS Ten RCTs were included. The pooled and the subgroup analysis revealed no significant difference in the wound infection rates, discharge rates, dehiscence rates, and PSS between TA (as an adjunct or closure method) and SCS or ST. TA (as an adjunct or closure method) was significantly (P < .00001) associated with a longer time to closure compared to ST and a shorter time compared to SCS as a closure method. Length of stay was comparable in all groups. CONCLUSION Using TA in combination with subcuticular sutures or ST or as a cutaneous method of closure does not provide additional benefits in terms of decreased hospital stay, decreased infection rates, or wound discharge rates. The PSS and pain scores of the scars also appear to be comparable to standard wound closure methods. No clear conclusion could be drawn regarding cosmetic scoring systems, because of the paucity of data. LEVEL OF EVIDENCE Level I (Meta-analysis of RCTs).
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Affiliation(s)
- Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aditya K S Gowda
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Place S, Forrester R. Tissue adhesive: should it be used in knee arthroplasty wound closure? J Wound Care 2021; 30:792-793. [PMID: 34644132 DOI: 10.12968/jowc.2021.30.10.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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