Abstract：
OBJECTIVE: To evaluate the effectiveness of prophylactic closed incision negative pressure wound therapy (ciNPWT) compared to conventional dressings in the prevention of periprosthetic joint infection (PJI) post hip and knee revision arthroplasty surgery.
METHODS: Five databases (MEDLINE, Embase., Emcare, CINAHL and Scopus) were searched with no date or language limits. Two independent reviewers assessed articles against the inclusion criteria and methodological quality of the 3 included studies. Data was extracted using a customised data tool and included the intervention, study methods and outcomes of interest. A meta-analysis was performed, and results presented in narrative form with forest plots.
RESULTS: The three studies, one randomized control trial and two quasi-experimental studies, included 136 intervention and 228 control participants (Sample 364). The PJI rate decreased in the ciNPWT cohort compared to the conservative dressing cohort (2 [1.47%] vs 27 [11.84%]). The reoperation rate was lower in the ciNPWT cohort versus the conventional cohort (4 [2.94%] vs 35 [15.35%]). The rate of wound complications was significantly decreased in the ciNPWT cohort compared to the conventional dressing cohort (14 [10.29%] v 85 [37.28), p=<0.001).
CONCLUSIONS: Prophylactic application of ciNPWT may be effective in reducing wound complications, PJI and reoperation post hip and knee revision arthroplasty surgery. The added cost of ciNPWT may be justified in the reduction of wound complications, PJI and reoperation. Ongoing trials determining if the prophylactic application of ciNPWT post hip and knee revision arthroplasty surgery is beneficial in preventing PJI particularly in high risk patients with additional comorbidities are warranted.
METHODS: Five databases (MEDLINE, Embase., Emcare, CINAHL and Scopus) were searched with no date or language limits. Two independent reviewers assessed articles against the inclusion criteria and methodological quality of the 3 included studies. Data was extracted using a customised data tool and included the intervention, study methods and outcomes of interest. A meta-analysis was performed, and results presented in narrative form with forest plots.
RESULTS: The three studies, one randomized control trial and two quasi-experimental studies, included 136 intervention and 228 control participants (Sample 364). The PJI rate decreased in the ciNPWT cohort compared to the conservative dressing cohort (2 [1.47%] vs 27 [11.84%]). The reoperation rate was lower in the ciNPWT cohort versus the conventional cohort (4 [2.94%] vs 35 [15.35%]). The rate of wound complications was significantly decreased in the ciNPWT cohort compared to the conventional dressing cohort (14 [10.29%] v 85 [37.28), p=<0.001).
CONCLUSIONS: Prophylactic application of ciNPWT may be effective in reducing wound complications, PJI and reoperation post hip and knee revision arthroplasty surgery. The added cost of ciNPWT may be justified in the reduction of wound complications, PJI and reoperation. Ongoing trials determining if the prophylactic application of ciNPWT post hip and knee revision arthroplasty surgery is beneficial in preventing PJI particularly in high risk patients with additional comorbidities are warranted.
摘要：
目的：评价预防性闭合切口负压伤口治疗（ciNPWT）与常规敷料相比，预防髋膝关节翻修术后假体周围感染（PJI）的有效性。
方法：五个数据库(MEDLINE，Embase.,Emcare,CINAHL和Scopus）进行了搜索，没有日期或语言限制。两名独立审稿人根据纳入的3项研究的纳入标准和方法学质量对文章进行了评估。使用定制的数据工具提取数据，并包括干预措施，研究方法和感兴趣的结果。进行了荟萃分析，结果以森林地块的叙事形式呈现。
结果：三项研究，一项随机对照试验和两项准实验研究，包括136名干预参与者和228名对照参与者(样本364)。与保守敷料组相比，ciNPWT组的PJI率降低(2[1.47%]vs27[11.84%])。ciNPWT队列的再手术率低于常规队列(4[2.94%]vs35[15.35%])。与常规敷料组相比，ciNPWT组的伤口并发症发生率显着降低（14[10.29％]v85[37.28），p=<0.001)。
结论：预防性应用cINPWT可有效减少伤口并发症，髋关节和膝关节置换术后的PJI和再次手术。ciNPWT的增加成本在减少伤口并发症方面可能是合理的，PJI和再手术。正在进行的试验确定在髋关节和膝关节置换术后预防性应用ciNPWT是否有利于预防PJI，特别是在具有其他合并症的高风险患者中。
方法：五个数据库(MEDLINE，Embase.,Emcare,CINAHL和Scopus）进行了搜索，没有日期或语言限制。两名独立审稿人根据纳入的3项研究的纳入标准和方法学质量对文章进行了评估。使用定制的数据工具提取数据，并包括干预措施，研究方法和感兴趣的结果。进行了荟萃分析，结果以森林地块的叙事形式呈现。
结果：三项研究，一项随机对照试验和两项准实验研究，包括136名干预参与者和228名对照参与者(样本364)。与保守敷料组相比，ciNPWT组的PJI率降低(2[1.47%]vs27[11.84%])。ciNPWT队列的再手术率低于常规队列(4[2.94%]vs35[15.35%])。与常规敷料组相比，ciNPWT组的伤口并发症发生率显着降低（14[10.29％]v85[37.28），p=<0.001)。
结论：预防性应用cINPWT可有效减少伤口并发症，髋关节和膝关节置换术后的PJI和再次手术。ciNPWT的增加成本在减少伤口并发症方面可能是合理的，PJI和再手术。正在进行的试验确定在髋关节和膝关节置换术后预防性应用ciNPWT是否有利于预防PJI，特别是在具有其他合并症的高风险患者中。
