Focus of Report: The focus of this Health Technology Assessment is evaluation of the effectiveness and safety of negative pressure wound therapy (NPWT) compared with conventional surgical wound care for the management of closed surgical incisions after total hip arthroplasty (THA).

Technology Description: The goal of prophylactic NPWT is to decrease the risk of complications and aid wound healing by removing exudate and debris, reducing bacterial contamination, protecting from external contamination, increasing local blood flow, holding wound edges together, and promoting the formation of granulation tissue. NPWT (also known as vacuum-assisted wound closure) is a therapeutic dressing system in which negative pressure is applied to a wound. The device comprises an occlusive dressing that is sealed over the wound and connected to drainage tubing connected to a suction pump that delivers negative pressure from –50 to –125 mm Hg.

Controversy: Despite a growing body of evidence on prophylactic NPWT, there is a lack of consensus concerning its use after THA for prevention of surgical wound complications. Conflicting evidence from higher-quality studies, including randomized controlled trials, contributes to this controversy regarding efficacy and whether NPWT provides sufficient benefit for this indication.

Key Questions:

  1. Is NPWT effective for promoting wound closure and preventing wound complications after THA?

  2. How does NPWT compare with established methods of surgical wound care after THA?

  3. Is NPWT for treatment of surgical sites after THA safe?

  4. Have definitive patient selection criteria been identified for the management of surgical wounds with NPWT after THA?

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