Silver-impregnated occlusive dressing is associated with a lower rate of acute surgical site infection after direct anterior total hip arthroplasty

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Abstract
Introduction The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained increasing adoption in recent years; however, it has been associated with a higher risk of wound-related complications compared with other surgical approaches. Silver-impregnated occlusive dressings have demonstrated antimicrobial potential, though their role in DAA THA remains underexplored. Materials and methods We conducted a retrospective cohort study with a historical control group, reviewing 321 consecutive primary DAA THAs performed by a single surgeon (September 2020–December 2025). Standard sterile gauze was used before August 2021 (n = 76) and a silver-impregnated occlusive dressing (AQUACEL® Ag SURGICAL; ConvaTec, Deeside, UK) thereafter (n = 245). Despite the chronological difference between cohorts, baseline demographic and clinical characteristics did not differ significantly between groups (Table 1). The primary endpoint was acute surgical site infection(SSI) within 30 days (CDC criteria); all patients had ≥ 3 months follow-up to capture early wound-related reoperations as secondary outcomes. Results Four acute SSI events occurred (1.25%). SSI incidence was 3.94% (3/76) with gauze versus 0.41% (1/245) with the silver-impregnated dressing (Fisher’s exact p = 0.043). This corresponds to an absolute risk reduction (ARR) of 3.54% (95% CI, 0.34–10.57) and a number needed to treat (NNT) of 29 (95% CI, 10–293). No deep PJI occurred. Given sparse events, adjusted analyses were considered exploratory; in a penalized (Firth) logistic model, silver dressing remained associated with lower odds of SSI, while higher BMI and diabetes were associated with higher odds. Conclusions In this retrospective historical-control cohort, silver-impregnated occlusive dressing use was associated with a lower 30-day SSI rate after DAA THA. Given the low event rate and potential temporal confounding, these findings should be interpreted cautiously and warrant confirmation in larger studies.
Funding Information
  • Tri-Service General Hospital Research Foundation (TSGH-D-113121)

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