closed incision negative pressure therapy versus standard of care surgical dressing in revision total knee arthroplasty

Conditions: Surgical Wound; Revision Total Knee Arthroplasty; Wounds and Injuries; Joint Disease; Musculoskeletal Disease; Prosthesis-Related Infections; Infection; Postoperative Complications; Pathologic Processes

Summary: this study evaluates surgical site complications in subjects undergoing revision of a total knee arthroplasty when closed incision negative pressure therapy is used to manage the closed incision, as compared to a standard of care dressing.


Eligibility criteria:
pre-operative inclusion criteria: the subject: * is at least 22 years of age on the date of informed consent * is able to provide their own informed consent * requires a tka revision defined as one of the following: 1. a one-stage aseptic revision procedure 2. a one-stage septic exchange procedure (requiring removal of all hardware) for acute postoperative infection 3. removal of cement spacer and re-implantation procedure 4. open reduction and internal fixation of peri-prosthetic fractures * has one or more of the following: 1. a body mass index (bmi) greater than 35 kg/m2 2. a requirement for the use of blood thinners other than acetylsalicylic acid (asa) after surgery 3. history of or current peripheral vascular disease 4. the presence of lymphedema in the operative limb 5. insulin-dependent diabetes mellitus 6. current tobacco use or previous history of smoking and quitting within the past 30 days 7. a history of prior infection of the operative site 8. current use of immunomodulators or steroids 9. current or history of cancer or hematological malignancy (excluding localized skin cancer) 10. rheumatoid arthritis 11. current renal failure or dialysis 12. malnutrition as determined by the investigator 13. liver disease as determined by the investigator 14. status post solid organ transplant 15. hiv * is willing and able to return for all scheduled study visits * if female, has a negative urine or serum pregnancy test at screening and day of revision surgery. women who have had surgical sterilization by a medically accepted method such as tubal ligation, hysterectomy, or oophorectomy or are post-menopausal, defined as not having menstruation for \>= 12 months will be excluded from requiring this test. intra-operative inclusion criteria: the subject: * continues to meet all pre-operative inclusion criteria * has undergone a tka revision resulting in a closed surgical incision pre-operative exclusion criteria: the subject: * is pregnant or lactating * will undergo a bilateral tka within the same operative visit * will undergo a bilateral tka in which the first tka surgery is on the knee selected for study * will undergo a staged bilateral tka in which the tka revision surgery for the knee under study occurs within 30 days of the first tka procedure * was previously randomized in this protocol * has a systemic active infection at the time of revision not including chronic viral infections such as hiv or hepatitis * has a remote-site skin infection at the time of revision * was tattooed on the area of the incision within 30 days prior to randomization * has known sensitivity to the study product components (drape and/or dressing materials in direct contact with the closed incision or skin) * has known sensitivity to silver * is currently enrolled in another investigational trial that requires additional interventions * is planned to be enrolled in another investigational trial that requires additional interventions at any time during the study * has localized skin cancer around the incision site intra-operative exclusion criteria: the subject: * is found to meet any of the pre-operative exclusion criteria * has a surgical incision that precludes placement of dressing * has a tka revision resulting in a muscle flap * has a tka revision resulting in the placement of a spacer * has an incision drainage and debridement procedure only * has a surgical incision closed with skin glue