Prior to the COVID-19 pandemic, about 750,000 total knee replacements and 450,000 total hip replacements were performed in the U.S. annually, with wound complications the No. 1 reason for hospital readmissions.
During a webinar sponsored by ConvaTec and hosted by Becker's ASC Review, four orthopedic surgeons discussed wound complications after total joint replacement and innovative therapies to optimize postoperative care.
- Javad Parvizi, MD. Rothman Orthopaedic Institute (Philadelphia)
- Bryan Springer, MD. OrthoCarolina (Charlotte, N.C.)
- Lee Rubin, MD. Yale Medicine (New Haven, Conn.)
- Will Long, MD. NYU Langone Health (New York City)
1. Value-based care amidst the pandemic: The pandemic has acted as catalyst for healthcare transformation, which will continue to be the case in the coming years, according to Dr. Springer. It has led providers to address the use of home health services and outpatient migration as technologies such as telemedicine and remote patient monitoring become increasingly prevalent.
2. Bundle busters: For total joint replacement, wound complications are the No. 1 reason for a hospital readmission, dubbed a "bundle buster," as it can significantly affect your bundle. For an average bundled payment of about $25,000, post-acute care services such as home health and home physical therapy account for more than a third of that, according to Dr. Springer. "We have to try and diminish many of these services" and develop "creative ways to manage our patients without direct patient contact," he said.
3. Innovations in wound dressing: Since 2017, the Aquacel Dressing has been the standard of care for total hip and knee replacements at Yale New Haven Hospital, according to Dr. Rubin, who began using the product in 2014. "It locks in the bacteria, contours to the wound bed and forms a gel that releases some of the silver ions to create an antibacterial matrix to trap and kill bacteria," he said. Aquacel drove down the infection rate compared to gauze dressing in multiple institutions, according to a study published in the Journal of Arthroplasty. "Our goal now is how to use it best," Dr. Rubin said.
4. Prolonged wound drainage: Hips that have persistent wound drainage — those that continue to drain beyond 72 hours after surgery — have three to four times greater risk of infection than those that heal normally, according to Dr. Parvizi. "Time is precious," he said. "Rothman Orthopaedic Institute found that if you let patients drain beyond five days, the surgical intervention that's implemented is less successful than if you had intervened earlier." Furthermore, the practice found intervening two weeks after joint replacement increases the likelihood of failure, leading to chronic infection.
5. Negative pressure wound therapy: ConvaTec's Avelle NPWT system has several benefits intended to promote wound healing. The disposable system is equipped with hydrofiber technology to maintain a moist wound healing environment and has a canister-less design to facilitate patient mobility and reduce maintenance for the surgical team. "My initial experience with the Avelle dressing is one of increased patient satisfaction and ease of care, for the patient, caregivers, myself and my office," Dr. Long said.