Tissue adhesive for wound closure, as adjunct to staples, reduces postoperative wound drainage after total knee arthroplasty

Background

Wound drainage after total knee or hip arthroplasty is a relatively frequent complication. It results in delayed mobilization, prolonged hospital stay, increased costs and is associated with an increased risk of infection. In this study, tissue adhesive was administered as an adjunct to skin closure with staples.

Methods

From February 2017, in a cohort of 1000 consecutive patients receiving primary total hip, total knee (TKA) or unicondylar knee arthroplasty, tissue adhesive was administered after skin closure with staples. Patients were prospectively analyzed for increased duration of hospital admission due to wound drainage. This cohort was compared to a consecutive cohort of 1000 patients before February 2017, treated with the same perioperative protocol, except for administration of tissue adhesive for skin closure. Difference in number of patients requiring prolonged hospital stay due to wound drainage was assessed between the two cohorts. Besides, costs of tissue adhesive were compared to change in hospital admission costs to assess the cost-effectiveness.

Results

The number of patients requiring prolonged hospital admission due to wound drainage was significantly reduced in the study group compared to the group not treated with tissue adhesive (39/990 patients vs. 68/961 patients, p = 0.002). The mean number of extra days of hospital admission due to wound drainage was also significantly lower in the tissue adhesive cohort (0.06 vs. 0.13 days). The mean number of extra days in hospital only proved to be significant in the TKA cohort. Total money saved by preventing prolonged hospital admission in general cohort amounted €19,610.

Conclusion

This study proves that tissue adhesive as an adjunct to staples for wound closure after total knee arthroplasty reduces wound drainage and is cost effective. Besides, this could potentially lead to lower rates of periprosthetic joint infection. Therefore, the use of tissue adhesive in total knee arthroplasty would be recommended.