A better strategy using barbed sutures for wound closure in total knee arthroplasty

Abstract

Aim: The purpose of this study was to conduct a meta-analysis to systematically compare the clinical outcomes between knee barbed sutures (KBS) and knee traditional sutures (KTS) for wound closure in total knee arthroplasty (TKA). Method: This study retrieved potential academic articles comparing the clinical outcomes between KBS and KTS in TKA from the MEDLINE database, the PubMed database, the EMBASE database and the Cochrane Library. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study. Results: A total of 14 articles (eight randomized controlled trials [RCTs], six non-RCTs) were involved in our study. The overall participants of barbed Sutures group were 1255, whereas it was 1247 in the traditional sutures. Our meta-analysis showed that KBS is preferable for wound closure of TKA as its shorter lower total cost (weighted mean difference [WMD] = -276.281, 95% CI = -480.281 to -72.280; p = 0.008) and wound closure time (WMD = -4.895,95% CI = -6.105 to -3.685; p < 0.001). However, there was no difference in any complications (p = 0.572), wound complications (p = 0.550), superficial infection (p = 0.918), deep infection (p = 0.654), wound dehiscence (p = 0.649), suture abscess (p = 0.939), arthrofibrosis (p = 0.970), needle sticks (p = 0.158), suture breakage (p = 0.371) and knee society scores (KSS; p = 0.073). Conclusion: The use of KBS in TKA is associated with significantly shortened wound closure times and total closure cost without increased risk of intraoperative needle sticks and suture breakage and postoperative incision complications. Given the relevant possible biases in our study, adequately powered and more RCTs with long-term follow-up are needed to compare the efficacy and safety between KBS and KTS.

Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials

“…To our knowledge, this is the first meta-analysis of only RCTs comparing the safety and efficacy of wound closure with KBS and KTS in primary TKA. We only found three metaanalyses [26][27][28] comparing barbed suture with versus conventional suture in primary TKA. However, the inclusion criteria of previous three meta-analyses included retrospective cohort studies design that are potentially subject to selection bias.…”

“…To date, we only found three meta-analyses [26][27][28] comparing barbed suture with versus conventional suture in primary TKA. Our meta-analysis had the same results as Zhang and Xin's study but had different results from studies of Meena.…”

“…Three meta-analyses have been performed, but all included several nonrandomized studies that are potentially subject to selection bias. [26][27][28] Moreover, the restriction of the previous meta-analyses to English language publications potentially limits the power that could be obtained with the inclusion of patient enrollment from non-English language studies. Thus, we performed this study to evaluate existing randomized-controlled trials (RCTs) comparing wound closure with KBS and KTS techniques from both English and International publications.…”

Operative Techniques to Reduce Hip and Knee Arthroplasty Complications in Morbidly Obese Patients

“…A constellation of suggestions from the literature for wound closure techniques include the use of bidirectional, running layers (>2-3 layers) of barbed sutures, including additional layers in thicker subcutaneous fat, which can then be reinforced in more superficial layers with interrupted sutures [ [62] , [63] , [64] ]. Running barbed sutures have been shown to decrease risk of infection due to their lower bacterial adherence [ 65 ], decreased time to wound closure, decreased cost [ 38 ], and decreased wound drainage and postoperative wound complications [ 66 ]. The use of bipolar sealant in heavier patients can help reinforce the wound and lower blood loss [ 67 ].…”