Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer
Background: Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following revie...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-08-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344121000881 |
| _version_ | 1818722804558725120 |
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| author | Mark A. Snyder, MD, FAOA, FAAOS Brian P. Chen, ScM Andrew Hogan, MSc George W.J. Wright, PhD |
| author_facet | Mark A. Snyder, MD, FAOA, FAAOS Brian P. Chen, ScM Andrew Hogan, MSc George W.J. Wright, PhD |
| author_sort | Mark A. Snyder, MD, FAOA, FAAOS |
| collection | DOAJ |
| description | Background: Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events. Methods: A systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity. Results: Forty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates. Conclusions: Considerable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| first_indexed | 2024-12-17T21:00:27Z |
| format | Article |
| id | doaj.art-628b4995050b43bbbeada03fb1b156ee |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-17T21:00:27Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-628b4995050b43bbbeada03fb1b156ee2022-12-21T21:32:44ZengElsevierArthroplasty Today2352-34412021-08-0110180189.e7Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue LayerMark A. Snyder, MD, FAOA, FAAOS0Brian P. Chen, ScM1Andrew Hogan, MSc2George W.J. Wright, PhD3Orthopaedic Center of Excellence, Good Samaritan Hospital, Cincinnati, OH, USA; Corresponding author. 375 Dixmyth Ave, Cincinnati, OH, 45220, USA. Tel.: +1 513-310-2733.Health Economics and Market Access, Ethicon, Inc, A Johnson & Johnson Company, Somerville, NJ, USAValue & Evidence Services, CRG-EVERSANA Canada Inc, Burlington, Ontario, CanadaValue & Evidence Services, CRG-EVERSANA Canada Inc, Burlington, Ontario, CanadaBackground: Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events. Methods: A systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity. Results: Forty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates. Conclusions: Considerable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.http://www.sciencedirect.com/science/article/pii/S2352344121000881Systematic reviewTotal knee arthroplastyTotal hip arthroplastyWound closureSurgical site infections |
| spellingShingle | Mark A. Snyder, MD, FAOA, FAAOS Brian P. Chen, ScM Andrew Hogan, MSc George W.J. Wright, PhD Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer Arthroplasty Today Systematic review Total knee arthroplasty Total hip arthroplasty Wound closure Surgical site infections |
| title | Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer |
| title_full | Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer |
| title_fullStr | Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer |
| title_full_unstemmed | Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer |
| title_short | Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer |
| title_sort | multilayer watertight closure to address adverse events from primary total knee and hip arthroplasty a systematic review of wound closure methods by tissue layer |
| topic | Systematic review Total knee arthroplasty Total hip arthroplasty Wound closure Surgical site infections |
| url | http://www.sciencedirect.com/science/article/pii/S2352344121000881 |
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