A comparison of three methods of wound closure following arthroplasty

Abstract

We carried out a blinded prospective randomised controlled trial comparing 2-octylcyanoacrylate (OCA), subcuticular suture (monocryl) and skin staples for skin closure following total hip and total knee arthroplasty. We included 102 hip replacements and 85 of the knee.OCA was associated with less wound discharge in the first 24 hours for both the hip and the knee. However, with total knee replacement there was a trend for a more prolonged wound discharge with OCA. With total hip replacement there was no significant difference between the groups for either early or late complications. Closure of the wound with skin staples was significantly faster than with OCA or suture. There was no significant difference in the length of stay in hospital, Hollander wound evaluation score (cosmesis) or patient satisfaction between the groups at six weeks for either hips or knees. We consider that skin staples are the skin closure of choice for both hip and knee replacements.

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

“…Many studies have previously compared wound closure techniques in TKA [2,3,6,[15][16][17][18]. Results have been highly variable and currently there is no consensus on a superior closure method.…”

“…Many studies have compared different closure techniques in TKA [2,3,6,[15][16][17][18]. From the perspective of wound complications, one recent meta-analysis by Smith et al showed that staple closure resulted in increased rates of infection after both hip and knee arthroplasty in comparison to running subcuticular [17].…”

“…Multiple studies have compared different closure techniques in TKA [2,3,6,[15][16][17][18]. The majority of these studies have involved running subcuticular closure versus staple closure and focused on factors such as cost, performance time, patient satisfaction, and wound complications.…”

Staples Equal Sutures for Skin Closure After Soft Tissue Tumor Resection

“…A series of prospective studies revealed inconsistent results, even among those comparing procedures at the hip [3,7,18,19,21]. A meta-analysis of several studies showed three times higher risk of infection with staples, but according to the authors, only ''one study met acceptable methodologic criteria'' [20].…”

“…Initially this decision was guided solely by physician preference; however, as concerns about cost, poor wound outcomes, and patient satisfaction have become increasingly important, attention has been focused on demonstrating a clear benefit of one method over the other to guide practice [3,7,9,[18][19][20][21]. No clear advantage between sutures or staples has been demonstrated, and authors have attempted to show the advantages of each method.…”