Safety and feasibility of collagen-based wound powder use in high-risk primary total joint arthroplasty patients

Post-operative complications during the 90-day global period are a concern after primary total joint arthroplasty (TJA), especially in high-risk patients. Biological wound powders, such as collagen with extracellular matrix/proteins (Xcellistem), may enhance wound healing. This study evaluates the feasibility and preliminary clinical outcomes of biologic wound powder in high-risk TJA patients as a proof-of-concept, comparing 90-day complications between a high-risk intervention cohort receiving the powder and a high-risk control cohort receiving no powder. High-risk patients were divided into those who received 500 mg of Xcellistem wound powder prior to closure and a high-risk control cohort who received no powder. High-risk status was defined using criteria adapted from the PROMISES randomized controlled trial, including BMI > 35 kg/m 2 , current smoking, insulin-dependent diabetes, peripheral vascular disease, lymphedema, immunomodulator or corticosteroid use, malignancy, rheumatoid arthritis, renal failure or dialysis, malnutrition, liver disease, solid organ transplant, or HIV infection. Surgical site complications included superficial or deep surgical site infection, dehiscence, seroma or hematoma requiring drainage, skin necrosis, continued drainage, dermatitis, or abscess formation. Categorical outcomes were compared using Fisher’s exact or chi-square testing, and continuous variables were compared using two-sample t-tests. A total of 179 TJA patients were evaluated: 91 consecutive high-risk patients treated with powder (age 69.9 ± 9.1 years; 56.0% female; BMI 34.9 ± 7.7) and 88 consecutive high-risk controls (age 67.2 ± 9.8 years; 70.5% female; BMI 38.0 ± 7.2). Within the 90-day postoperative period, SSCs occurred in 4 control patient and 1 intervention patients (4.6 vs. 1.1%, P = 0.206). No cases of SSI, dehiscence, hematoma, or abscess formation were observed in either group. Seroma and dermatitis each occurred in 1 control patient and 0 intervention patients, while continued drainage occurred in 2 control patients and 1 intervention patient ( P = 0.617). All-cause reoperations occurred in 1 control patient and 3 intervention patients (1.1 vs. 3.3%, P = 0.621). In this preliminary retrospective chart review, collagen-based wound powder use in high-risk primary TJA patients was associated with low 90-day surgical site complication rates. These proof-of-concept findings support the safety of biologic wound powder in high-risk TJA patients and warrant further investigation in adequately powered comparative trials. Larger matched or randomized studies are needed to determine whether collagen-based wound powders independently reduce postoperative wound complications.