BackgroundEvaluation of the Zip surgical skin closure device (Zip) versus metal staples regarding patient satisfaction and cosmesis after total knee arthroplasty (TKA). MethodsPatients undergoing TKA at Einstein Medical Center Montgomery were randomized to receive skin closure using Zip or staples. Patient satisfaction was assessed by surveys at discharge, three weeks and six weeks post-operatively. Cosmesis according to patients and observers was assessed using the Patient and Observer Scar Assessment Scale (POSAS). ResultsRandomization resulted in 21 Zip and 20 staple patients. Two subjects were lost to follow-up and one patient suffered cardiac arrest. Surgeon satisfaction favored Zip over staples on day of surgery and patient discharge. At three weeks, Zip was favored over staples for patient-reported movement and device removal pain. Patient satisfaction results favored Zip for comfort, ease of wound care, and hospital selection based on wound closure. POSAS favored Zip for appearance, pain, itching, color, stiffness, thickness, irregularity, vascularity, pigmentation, relief, pliability, surface area, and observer opinion. Subject opinion resulted in no difference between groups. At six weeks, no differences were found for patient-rated movement pain or ease of wound care. POSAS favored Zip for color, stiffness, thickness, vascularity, pigmentation, thickness, relief, pliability, surface area and observer opinion. ConclusionSatisfaction with the closure method and patient and physician assessments of cosmesis were superior with Zip. Orthopedic surgeons strive to optimize TKA patient satisfaction. Skin closure can influence patient satisfaction as the memory of their recovery fades and the scar remains the most visible reminder of their experience.