Download PDF
J Knee Surg 2022; 35(12): 1301-1305
DOI: 10.1055/s-0041-1724137
Original Article

The Cost-Effectiveness of Closed Incisional Negative Pressure Wound Therapy for Infection Prevention after Revision Total Knee Arthroplasty

Nicholas R. Pagani 
1   Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
,
Michael A. Moverman
1   Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
,
Richard N. Puzzitiello
1   Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
,
Mariano E. Menendez
1   Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
,
Joseph J. Kavolus
1   Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Recent investigations have shown that closed incisional negative pressure wound therapy (ciNPWT) decreases the rate of postoperative wound complications following revision total knee arthroplasty (TKA). In this study, we used a break-even analysis to determine whether ciNPWT is a cost-effective measure for reducing prosthetic joint infection (PJI) after revision TKA. The cost of ciNPWT, cost of treatment for PJI, and baseline infection rates following revision TKA were collected from institutional data and the literature. The absolute risk reduction (ARR) in infection rate necessary for cost-effectiveness was calculated using break-even analysis. Using our institutional cost of ciNPWT ($600), this intervention would be cost-effective if the initial infection rate of revision TKA (9.0%) has an ARR of 0.92%. The ARR needed for cost-effectiveness remained constant across a wide range of initial infection rates and declined as treatment costs increased. The use of ciNPWT for infection prevention following revision TKA is cost-effective at both high and low initial infection rates, across a broad range of treatment costs, and at inflated product expenses.

Keywords

prosthetic joint infection - revision - total knee arthroplasty - cost - negative pressure wound therapy


Publication History

Received: 14 August 2020

Accepted: 29 November 2020

Article published online:
28 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bozic KJ, Kurtz SM, Lau E. et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 2 Kamath AF, Ong KL, Lau E. et al. Quantifying the burden of revision total joint arthroplasty for periprosthetic infection. J Arthroplasty 2015; 30 (09) 1492-1497
    CrossrefPubMedGoogle Scholar
  • 3 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (8, Suppl): 61-5.e1
    CrossrefPubMedGoogle Scholar
  • 4 Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23 (07) 984-991
    CrossrefPubMedGoogle Scholar
  • 5 Mortazavi SMJ, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J. Revision total knee arthroplasty infection: incidence and predictors. Clin Orthop Relat Res 2010; 468 (08) 2052-2059
    CrossrefPubMedGoogle Scholar
  • 6 Phillips JE, Crane TP, Noy M, Elliott TSJ, Grimer RJ. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 2006; 88 (07) 943-948
    CrossrefPubMedGoogle Scholar
  • 7 Nikolaus OB, McLendon PB, Hanssen AD, Mabry TM, Berbari EF, Sierra RJ. Factors associated with 20-year cumulative risk of infection after aseptic index revision total knee arthroplasty. J Arthroplasty 2016; 31 (04) 872-877
    CrossrefPubMedGoogle Scholar
  • 8 Suarez J, Griffin W, Springer B, Fehring T, Mason JB, Odum S. Why do revision knee arthroplasties fail?. J Arthroplasty 2008; 23 (6, suppl 1): 99-103
    CrossrefPubMedGoogle Scholar
  • 9 Kasch R, Merk S, Assmann G. et al. Comparative analysis of direct hospital care costs between aseptic and two-stage septic knee revision. PLoS One 2017; 12 (01) e0169558
    CrossrefPubMedGoogle Scholar
  • 10 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    Google Scholar
  • 11 Saleh K, Olson M, Resig S. et al. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res 2002; 20 (03) 506-515
    CrossrefPubMedGoogle Scholar
  • 12 Wagenaar FBM, Löwik CAM, Zahar A, Jutte PC, Gehrke T, Parvizi J. Persistent wound drainage after total joint arthroplasty: a narrative review. J Arthroplasty 2019; 34 (01) 175-182
    CrossrefPubMedGoogle Scholar
  • 13 Vince K, Chivas D, Droll KP. Wound complications after total knee arthroplasty. J Arthroplasty 2007; 22 (4, suppl 1): 39-44
    CrossrefPubMedGoogle Scholar
  • 14 Galat DD, McGovern SC, Larson DR, Harrington JR, Hanssen AD, Clarke HD. Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joint Surg Am 2009; 91 (01) 48-54
    CrossrefPubMedGoogle Scholar
  • 15 Jaberi FM, Parvizi J, Haytmanek CT, Joshi A, Purtill J. Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res 2008; 466 (06) 1368-1371
    CrossrefPubMedGoogle Scholar
  • 16 Weiss AP, Krackow KA. Persistent wound drainage after primary total knee arthroplasty. J Arthroplasty 1993; 8 (03) 285-289
    CrossrefPubMedGoogle Scholar
  • 17 Adelani MA, Johnson SR, Keeney JA, Nunley RM, Barrack RL. Clinical outcomes following re-admission for non-infectious wound complications after primary total knee replacement. Bone Joint J 2014; 96-B (05) 619-621
    CrossrefPubMedGoogle Scholar
  • 18 Sakellariou VI, Poultsides LA, Vasilakakos T, Sculco P, Ma Y, Sculco TP. Risk factors for recurrence of periprosthetic knee infection. J Arthroplasty 2015; 30 (09) 1618-1622
    CrossrefPubMedGoogle Scholar
  • 19 Newman JM, Siqueira MBP, Klika AK, Molloy RM, Barsoum WK, Higuera CA. Use of closed incisional negative pressure wound therapy after revision total hip and knee arthroplasty in patients at high risk for infection: a prospective, randomized clinical trial. J Arthroplasty 2019; 34 (03) 554-559.e1
    CrossrefPubMedGoogle Scholar
  • 20 Cooper HJ, Bas MA. Closed-incision negative-pressure therapy versus antimicrobial dressings after revision hip and knee surgery: a comparative study. J Arthroplasty 2016; 31 (05) 1047-1052
    CrossrefPubMedGoogle Scholar
  • 21 Nherera LM, Trueman P, Karlakki SL. Cost-effectiveness analysis of single-use negative pressure wound therapy dressings (sNPWT) to reduce surgical site complications (SSC) in routine primary hip and knee replacements. Wound Repair Regen 2017; 25 (03) 474-482
    CrossrefPubMedGoogle Scholar
  • 22 Hatch MD, Daniels SD, Glerum KM, Higgins LD. The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis. J Shoulder Elbow Surg 2017; 26 (03) 472-477
    CrossrefPubMedGoogle Scholar
  • 23 Kerbel YE, Sunkerneni AR, Kirchner GJ, Prodromo JP, Moretti VM. The cost-effectiveness of preoperative staphylococcus aureus screening and decolonization in total joint arthroplasty. J Arthroplasty 2018; 33 (7S): S191-S195
    CrossrefPubMedGoogle Scholar
  • 24 Kerbel YE, Kirchner GJ, Sunkerneni AR, Lieber AM, Moretti VM. The cost effectiveness of dilute Betadine lavage for infection prophylaxis in total joint arthroplasty. J Arthroplasty 2019; 34 (7S): S307-S311
    CrossrefPubMedGoogle Scholar
  • 25 Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN, Bozic KJ. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty 2010; 25 (6, Suppl): 103-107
    CrossrefPubMedGoogle Scholar
  • 26 Streubel PN, Stinner DJ, Obremskey WT. Use of negative-pressure wound therapy in orthopaedic trauma. J Am Acad Orthop Surg 2012; 20 (09) 564-574
    CrossrefPubMedGoogle Scholar
  • 27 Pleger SP, Nink N, Elzien M, Kunold A, Koshty A, Böning A. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study. Int Wound J 2018; 15 (01) 75-83
    CrossrefPubMedGoogle Scholar
  • 28 Siqueira MBP, Ramanathan D, Klika AK, Higuera CA, Barsoum WK. Role of negative pressure wound therapy in total hip and knee arthroplasty. World J Orthop 2016; 7 (01) 30-37
    CrossrefPubMedGoogle Scholar
  • 29 Karlakki SL, Hamad AK, Whittall C, Graham NM, Banerjee RD, Kuiper JH. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: a randomised controlled trial. Bone Joint Res 2016; 5 (08) 328-337
    CrossrefPubMedGoogle Scholar
  • 30 Manoharan V, Grant AL, Harris AC, Hazratwala K, Wilkinson MPR, McEwen PJC. Closed incision negative pressure wound therapy vs conventional dry dressings after primary knee arthroplasty: a randomized controlled study. J Arthroplasty 2016; 31 (11) 2487-2494
    CrossrefPubMedGoogle Scholar
  • 31 Pachowsky M, Gusinde J, Klein A. et al. Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty. Int Orthop 2012; 36 (04) 719-722
    CrossrefPubMedGoogle Scholar
  • 32 Redfern RE, Cameron-Ruetz C, O'Drobinak SK, Chen JT, Beer KJ. Closed incision negative pressure therapy effects on postoperative infection and surgical site complication after total hip and knee arthroplasty. J Arthroplasty 2017; 32 (11) 3333-3339
    CrossrefPubMedGoogle Scholar
  • 33 Cooper HJ, Roc GC, Bas MA. et al. Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee. Injury 2018; 49 (02) 386-391
    CrossrefPubMedGoogle Scholar
  • 34 Lee AJ, Sheppard CE, Kent WDT, Mewhort H, Sikdar KC, Fedak PWM. Safety and efficacy of prophylactic negative pressure wound therapy following open saphenous vein harvest in cardiac surgery: a feasibility study. Interact Cardiovasc Thorac Surg 2017; 24 (03) 324-328
    PubMedGoogle Scholar
  • 35 Hyldig N, Vinter CA, Kruse M. et al. Prophylactic incisional negative pressure wound therapy reduces the risk of surgical site infection after caesarean section in obese women: a pragmatic randomised clinical trial. BJOG 2019; 126 (05) 628-635
    CrossrefPubMedGoogle Scholar
  • 36 Hall C, Regner J, Abernathy S. et al. Surgical site infection after primary closure of high-risk surgical wounds in emergency general surgery laparotomy and closed negative-pressure wound therapy. J Am Coll Surg 2019; 228 (04) 393-397
    CrossrefPubMedGoogle Scholar
  • 37 Stannard JP, Volgas DA, Stewart R, McGwin Jr G, Alonso JE. Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma 2009; 23 (08) 552-557
    CrossrefPubMedGoogle Scholar
  • 38 Stannard JP, Volgas DA, McGwin III G. et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 2012; 26 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 39 Reddix Jr RN, Tyler HK, Kulp B, Webb LX. Incisional vacuum-assisted wound closure in morbidly obese patients undergoing acetabular fracture surgery. Am J Orthop 2009; 38 (09) 446-449
    CrossrefPubMedGoogle Scholar
  • 40 Reddix Jr RN, Leng XI, Woodall J, Jackson B, Dedmond B, Webb LX. The effect of incisional negative pressure therapy on wound complications after acetabular fracture surgery. J Surg Orthop Adv 2010; 19 (02) 91-97
    PubMedGoogle Scholar
  • 41 Hansen E, Durinka JB, Costanzo JA, Austin MS, Deirmengian GK. Negative pressure wound therapy is associated with resolution of incisional drainage in most wounds after hip arthroplasty. Clin Orthop Relat Res 2013; 471 (10) 3230-3236
    CrossrefPubMedGoogle Scholar
  • 42 Parisi TJ, Konopka JF, Bedair HS. What is the long-term economic societal effect of periprosthetic infections after THA? A Markov analysis. Clin Orthop Relat Res 2017; 475 (07) 1891-1900
    CrossrefPubMedGoogle Scholar