TY - JOUR
T1 - Goals, challenges and strategies for wound and bleeding management in total knee arthroplasty
T2 - A modified Delphi method
AU - Lyons, Matthew
AU - Nunley, Ryan M.
AU - Ahmed Shokri, Amran
AU - Doneley, Tyson
AU - Han, Hyuk Soo
AU - Harato, Kengo
AU - Kuwasawa, Ayano
AU - Lee, Dae Hee
AU - Qi, Xin
AU - Qian, Wenwei
AU - Ratanachai, Siripong
AU - Wang, Weijun
AU - Po-Han Chen, Brian
AU - Danker, Walter
N1 - Funding Information:
The authors thank the investigators and their teams who took part in this study. The authors acknowledge Akie Seno for input on a previous version of the manuscript and also acknowledge Ruth Le Fevre, Costello Medical Consulting Ltd and Schezn Lim, Costello Medical Singapore Pte Ltd for medical writing and editorial assistance based on the authors’ input and direction. The authors also acknowledge and authorize Claudia Tay Siu Wen, Costello Medical Singapore Pte Ltd for assistance with submitting this article on behalf of the authors. Support for third-party writing and submission assistance for this article was funded by Johnson & Johnson in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3). The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Johnson & Johnson.
Funding Information:
The authors thank the investigators and their teams who took part in this study. The authors acknowledge Akie Seno for input on a previous version of the manuscript and also acknowledge Ruth Le Fevre, Costello Medical Consulting Ltd and Schezn Lim, Costello Medical Singapore Pte Ltd for medical writing and editorial assistance based on the authors’ input and direction. The authors also acknowledge and authorize Claudia Tay Siu Wen, Costello Medical Singapore Pte Ltd for assistance with submitting this article on behalf of the authors. Support for third-party writing and submission assistance for this article was funded by Johnson & Johnson in accordance with Good Publication Practice (GPP3) guidelines ( http://www.ismpp.org/gpp3 ).
Funding Information:
The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: M Lyons: Received personal fees and non-financial support from Johnson and Johnson-Ethicon; grants from DePuy Synthes; personal fees from Corin and Zimmer Biomet. RM Nunley: Served as a paid consultant for Biocomposites, DePuy, Medtronic, Microport, Mirus, Smith & Nephew and ROM Tech; received stock options, royalties from Hyalex, Microport and ROM Tech; served as designer from Depuy, Smith & Nephew and Microport. T Doneley: Received personal fees from DePuy, stock options from Hip360 (Kico innovations). HS Han: Received grants from Korea Health Industry Development Institute and National Research Foundation of Korea. BPH Chen, W Danker III: Employee of Ethicon (Johnson and Johnson). AA Shokri, K Harato, A Kuwasawa, DH Lee, X Qi, W Qian, S Ratanachai, W Wang: Nothing to disclose.
Publisher Copyright:
© The Author(s) 2022.
PY - 2022/9
Y1 - 2022/9
N2 - Background: Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available. Methods: Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September–October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework. Results: Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. Conclusion: Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.
AB - Background: Surgical techniques related to soft tissue management play critical roles in optimizing surgical outcomes and patient satisfaction in total knee arthroplasty (TKA). Despite the importance of wound closure and bleeding management approaches, no published guidelines/consensus are available. Methods: Twelve orthopedic surgeons participated in a modified Delphi panel consisting of 2 parts (each part comprising two rounds) from September–October 2018. Questionnaires were developed based on published evidence and guidelines on surgical techniques/materials. Questionnaires were administered via email (Round 1) or at a face-to-face meeting (subsequent rounds). Panelists ranked their agreement with each statement on a five-point Likert scale. Consensus was achieved if ≥70% of panelists selected 4/5, or 1/2. Statements not reaching consensus in Round 1 were discussed and repeated or modified in Round 2. Statements not reaching consensus in Round 2 were excluded from the final consensus framework. Results: Consensus was reached on 13 goals of wound management. Panelists agreed on 38 challenges and 71 strategies addressing surgical techniques or wound closure materials for each tissue layer, and management strategies for blood loss reduction or deep vein thrombosis prophylaxis in TKA. Statements on closure of capsular and skin layers, wound irrigation, dressings and drains required repeat voting or modification to reach consensus. Conclusion: Consensus from Asia-Pacific TKA experts highlights the importance of wound management in optimizing TKA outcomes. The consensus framework provides a basis for future research, guidance to reduce variability in patient outcomes, and can help inform recommendations for wound management in TKA.
KW - Asia
KW - Delphi technique
KW - Oceania
KW - total knee arthroplasty
KW - wound closure techniques
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U2 - 10.1177/10225536221138985
DO - 10.1177/10225536221138985
M3 - Article
C2 - 36374258
AN - SCOPUS:85141933728
SN - 1022-5536
VL - 30
JO - Journal of Orthopaedic Surgery
JF - Journal of Orthopaedic Surgery
IS - 3
ER -