International Delphi Study on Wound Closure and Dressing Management in Joint Arthroplasty: Part 1: Total Knee Arthroplasty

Margaret Ainslie-Garcia, Lucas A. Anderson, Benjamin V. Bloch, Tim N. Board, Antonia F. Chen, Samantha Craigie, Walter Danker, Najmuddin Gunja, James Harty, Victor H. Hernandez, Kate Lebedeva, Michael A. Mont, Ryan M. Nunley, Javad Parvizi, Carsten Perka, Nicolas S. Piuzzi, Ola Rolfson, Joshua Rychlik, Emilio Romanini, Pablo Sanz-RuizRafael J. Sierra, Linda Suleiman, Eleftherios Tsiridis, Pascal André Vendittoli, Helge Wangen, Luigi Zagra

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA). Methods: The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review. Consensus was developed for the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of ≥ 75% was required for consensus. Results: All 26 statements achieved consensus after three rounds of anonymous voting. Wound closure-related interventions that were recommended for use in TKA included: 1) closing in semi-flexion versus extension (superior range of motion); 2) using aspirin for venous thromboembolism prophylaxis over other agents (reduces wound complications); 3) barbed sutures over non-barbed sutures (lower wound complications, better cosmetic appearances, shorter closing times, and overall cost savings); 4) mesh-adhesives over other skin closure methods (lower wound complications, higher patient satisfaction scores, lower rates of readmission); 5) silver-impregnated dressings over standard dressings (lower wound complications, decreased infections, fewer dressing changes); 6) in high-risk patients, negative pressure wound therapy over other dressings (lower wound complications, decreased reoperations, fewer dressing changes); and 7) using triclosan-coated over non-antimicrobial-coated sutures (lower risks of surgical site infection). Conclusions: Using a modified Delphi approach, the panel achieved consensus on 26 statements pertaining to wound closure and dressing management in TKA. This study forms the basis for identifying critical evidence supported by clinical practice for wound management to help reduce variability, advance standardization, and ultimately improve outcomes during TKA. The results presented here can serve as the foundation for knowledge, education, and improved clinical outcomes for surgeons performing TKAs.

Original languageEnglish
Pages (from-to)878-883
Number of pages6
JournalJournal of Arthroplasty
Volume39
Issue number4
DOIs
StatePublished - Apr 2024

Keywords

  • Delphi study
  • dressing management
  • surgical best practices
  • total knee arthroplasty
  • venous thromboembolism prophylaxis
  • wound closure techniques

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