Similar infection rates in a new wound closure method following knee arthroplasty

Background and objective: To evaluate the effectiveness of vacuum-assisted closure (VAC) in the treatment of Fournier gangrene (FG). Material and methods: Forty-eight male patients treated for Fournier gangrene were included in the study. The patients were divided into two groups (Group I: conventional dressing, Group II: VAC therapy). Characteristics of the patients, laboratory parameters, number of debridement procedures, daily number of dressings, visual analogue scale (VAS) during dressing, analgesic requirement, colostomy requirement, time from the first debridement to wound closure, wound closure method, length of hospital stay, and mortality rates were compared. Results: Group I comprised 33 patients and Group II comprised 15 patients. The number of dressings, VAS score and daily analgesic requirement were statistically significantly lower in Group II (p < 0.05) than in Group I. The number of debridement procedures, colostomy requirement, orchiectomy rate, time from first debridement to wound closure, length of hospital stay, wound closure method and mortality rate were similar between these two groups (p > 0.05). Conclusion: The clinical results of conventional dressing and VAC therapy were similar for treating FG. VAC therapy is an effective postoperative wound care method that offers less requirement for dressing changes, less pain, less analgesic requirement and more patient satisfaction compared to conventional dressing.

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A symmetric anchor designed barbed suture versus conventional interrupted sutures in total knee arthroplasty: A multicenter, randomized controlled trial

Journal of Orthopaedic Surgery ◽

10.1177/2309499020965681 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096568

Author(s):

Wei Wang ◽

Shigui Yan ◽

Feng Liu ◽

Wei Chai ◽

Jianlin Zuo ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Randomized Controlled Trial ◽

Knee Arthroplasty ◽

Wound Closure ◽

Controlled Trial ◽

Barbed Suture ◽

Surgical Incision ◽

Randomized Controlled ◽

Closure Time ◽

Total Knee

Objective: This randomized controlled study was designed to compare the wound closure efficacy and safety of barbed suture in comparison to the conventional interrupted suture for total knee arthroplasty (TKA). Methods: This multicenter, single-blind, randomized controlled trial enrolled 184 patients who underwent elective TKA between June 2017 and April 2018. The subjects were randomized between two groups. Surgical incision closure time was considered as the primary end point. Results: A total of 184 patients participated in this randomized controlled trial; 91 patients had wound closure that involved barbed suture and 93 patients underwent conventional treatment—that is interrupted suturing with nonbarbed sutures. The surgical incision closure time was shorter ( p < 0.0001) in the barbed suture group compared with the control group (15.5 ± 4.88 vs. 20.9 ± 6.30 min). However, both groups were found to be equal in terms of the rate of postoperative complications. Conclusion: Usage of the symmetric anchor designed barbed suture is safe, efficacious, and demonstrates a decrease in surgical incision closure time in patients undergoing TKA compared to interrupted closure using conventional sutures. Future studies are warranted to demonstrate clinical and economic benefits of barbed sutures.

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Dual Antibiotic Prophylaxis in Total Knee Arthroplasty: Where Do We Stand?

The Journal of Knee Surgery ◽

10.1055/s-0039-1695742 ◽

2019 ◽

Vol 33 (02) ◽

pp. 100-105 ◽

Cited By ~ 1

Author(s):

Jesus M. Villa ◽

Tejbir S. Pannu ◽

Aldo M. Riesgo ◽

Preetesh D. Patel ◽

Michael A. Mont ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Antibiotic Prophylaxis ◽

Knee Arthroplasty ◽

Postoperative Infection ◽

Prophylactic Antibiotic ◽

The United States ◽

Prophylactic Antibiotics ◽

Infection Rates ◽

Mrsa Infection ◽

Total Knee

AbstractThe risk of surgical site infection in primary total knee arthroplasty (TKA) has been reduced with the use of prophylactic antibiotics. First or second generation cephalosporins are still recommended as the primary prophylactic choice, but with the rise in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, evidence has emerged in favor of using dual antibiotics including vancomycin. However, it is unclear whether these combinations of antibiotic regimens further reduce postoperative infection rates. As a result, the objective of this review is to summarize the current literature concerning the use of dual prophylactic antibiotics in TKA. The most common dual prophylactic antibiotic combination is cefazolin (C) and vancomycin (V). In general, when comparing the effectiveness of single versus dual antibiotics, conflicting results have been reported. Three studies demonstrated no substantial decrease in overall postoperative infection rates with the use of dual antibiotics when compared with cefazolin alone. One found a significant decrease only in MRSA infection rates when using cefazolin and vancomycin (CV) (0.8% C alone vs. 0.08% CV, p < 0.05). Another investigation evaluated revision TKA patients who had combined cefazolin and vancomycin prophylaxis and showed a significant decline in both overall infection (7.89% [C] vs. 3.13% [CV]) and MRSA infection rates (4.21% [C] vs. 0.89% [CV]; p < 0.05). Concerning the safety profile of dual antibiotics, particular precautions must be adopted with the use of vancomycin because of the risk of acute kidney injury. Instead of vancomycin, an alternate less nephrotoxic antibiotic option might be teicoplanin. Unfortunately, this latter agent is only available outside of the United States. In conclusion, the value of dual antibiotic prophylaxis for the prevention of periprosthetic knee infections remains unclear primarily because all comparative studies performed between dual and single antibiotics have been of low evidence with retrospective designs. Larger multicenter randomized controlled trials are warranted.

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