[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain

P Sanz Ruiz; J R Caeiro Rey; J C Martínez Pastor; J L Martín Alguacil; A Murcia Asensio; J Moreta Suárez

doi:10.1016/j.recot.2023.11.005

[Translated article] Wound closure after knee and hip replacement (TKA and THA): Survey results on the clinical practice in Spain

Rev Esp Cir Ortop Traumatol. 2024 Mar-Apr;68(2):T97-T107. doi: 10.1016/j.recot.2023.11.005. Epub 2023 Nov 20.

[Article in English, Spanish]

Authors

P Sanz Ruiz¹, J R Caeiro Rey², J C Martínez Pastor³, J L Martín Alguacil⁴, A Murcia Asensio⁵, J Moreta Suárez⁶

Affiliations

¹ Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: pablo.sanzruiz@gmail.com.
² Servicio de Cirugía Ortopédica y Traumatología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
³ Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic de Barcelona, Barcelona, Spain.
⁴ Servicio de Cirugía Ortopédica y Traumatología, Hospital Vithas de Granada, Granada, Spain.
⁵ Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Reina Sofía, Murcia, Spain.
⁶ Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Galdakao-Usansolo, Bizkaia, Spain.

PMID: 37992859
DOI: 10.1016/j.recot.2023.11.005

Abstract

Background and objective: In orthopaedic surgery, it is clear that an optimal standardised closure technique has not yet been developed. Locally, there are no objective data describing the standard surgical practice in wound closure. The aim of this study is to analyse the clinical practice of surgical wound closure in orthopaedic surgery by means of a survey of a representative local sample and thus obtain information on the context of closure in Spain.

Material and method: An ad hoc group of specialists in orthopaedic surgery and traumatology was formed. The group of experts, after analyzing the literature, developed a questionnaire of 32 closed multiple-choice questions divided into the following blocks: hemostasis, surgical wound closure (deep, superficial, and cutaneous), and dressings.

Results: A total of 471 surgeons responded to the survey completely and with sufficient information to perform the descriptive analysis. 79% believe that ATX can influence the decrease in surgical site infection rate. 96% believe that the type of deep closure at the level of the arthrotomy could influence outcomes and complications after hip and/or knee replacements. 85% believe that the type of shallow closure at the subcutaneous level may influence outcomes and complications after hip and/or knee replacement. 64% of surgeons use single-use incisional negative pressure therapy for the treatment of surgical wound complications (seroma, prolonged drainage, dehiscence).

Conclusions: There is a high level of variability in wound closure in our setting and a low level of training on the subject. The authors recommend that the different scientific societies invest resources to improve training in this field and reduce the percentage of surgeons who are considered inadequately trained, as well as adapting closure techniques to those considered gold standard according to the evidence.

Keywords: Cierre de heridas; Cirugía protésica; Encuesta; Manejo de partes blandas; Orthopaedic surgery; Práctica quirúrgica en España; Soft tissue management; Surgical practice in Spain; Survey; Wound closure.