Negative pressure wound therapy (NPWT) versus conventional wound dressings in Total Knee Arthroplasty

There will be two phases to our study. Phase 1 will be purely observational to elucidate a baseline costing. The patients will be treated with the conventional dry dressings regularly utilised by the surgeons. This phase will last 2 months. Unilateral and bilateral total knee Arthroplasty patients will be recruited into this phase. ‘ Phase 2 will be a randomised controlled trial comparing patient satisfaction and cost between negative wound pressure therapy and conventional dry dressings. Patients undergoing bilateral knee arthroplasty will be recruited and have each knee randomised to either receiving NPWT or CDD. We expect this phase to last 8-12 months to recruit the required number of patients. The negative pressure dressing will be left intact till wound review between 10-12 days in outpatient clinic. Surgical wounds in these patients will be managed with negative pressure wound therapy (NPWT). Negative Pressure Wound Therapy (NPWT) has been used for many years for treatment of chronic wounds and more recently for post arthroplasty wound management. Orthopaedic surgeons are proactive in their consideration on surgical dressings in attempts to avoid costly post arthroplasty wound infections; at face value the closed, portable dressing system appears to provide an attractive option for wound care. NPWT consists of a closed, sealed system that applies negative pressure (suction) to the wound surface. The dressing is suggested to support primary intention to heal by improving local blood flow, facilitate oedema and exudate removal, reducing bacterial contamination, and promoting incision healing.The dressing will be applied by the surgeon at completion of surgery and left intact until the post-operative review appointment at 2 weeks post op. The patients will be discharged from hospital with a small canister attached to the dressing for collection of excess fluid.