Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomized Controlled Trial

Chan, Vincent Wk; Chan, PK; Chiu, K. Y.; Yan, Chun-Hoi; Ng, Florrie Fei Yin

doi:10.1016/j.arth.2016.12.015

Cited by 64 publications

(80 citation statements)

References 15 publications

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“…1). There were 8 RCTs and 3 non-RCTs, with a total of 1546 TKAs from USA [4,[10][11][12][13][14][15], China [16,17], India [18], and Spain [19]. Surgical approach, time for capsule suture, superficial wound infection, deep wound infection, wound dehiscence, suture breakage, needlestick, A, Representativeness of the exposed cohort; B, Selection of the non-exposed cohort; C, Ascertainment of exposure; D, Demonstration that outcome of interest was not present at start of study; E, Comparability of cohorts on the basis of the design or analysis; F, Assessment of outcome; G, was follow-up long enough for outcomes to occur; F, Adequacy of follow up of cohorts (http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp)…”

Section: Resultsmentioning

confidence: 99%

A comparison between barbed suture and conventional suture in total knee arthroplasty: a systematic review and meta-analysis

Niu

et al. 2020

Arthroplasty

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Objective: The aim of this systematic review and meta-analysis was to evaluate the efficacy of barbed versus conventional sutures in total knee arthroplasty. Methods: Two investigators independently performed data extraction and assessed study quality using the keywords "barbed suture, wound suture, total knee arthroplasty" in two search trials, individual trials, and trials from Systematic Reviews or Meta-analyses in PubMed, Cochrane Library, Web of Science, and EMBASE databases. Result: A total of 11 articles (involving 1546 total knee arthroplasties) were included in this study. Comparison was made between barbed and conventional sutures in terms of various measures. No significant differences were identified in superficial infection and deep infection (p > 0.51; odds ratio 0.84 [95% confidence interval, 0.50, 1.4] and p > 0.28; odds ratio 0.50 [95% confidence interval, 0.14, 1.75], respectively). There was no significant difference in time for capsular suture (p < 0.05; odds ratio − 4.05 [95% confidence interval, − 4.39, − 3.71]). There existed no significant differences in Hospital for Special Surgery Knee Score and Knee Society Score (p > 0.05; odds ratio − 1.20 [95% confidence interval, − 2.98, 0.58] and p > 0.05; odds ratio − 1.62 [95% confidence interval, − 4.06, 0.18], respectively). No significant differences were revealed in suture breakage and needle stick injury (p < 0.05; odds ratio 36.51 [95% confidence interval, 7.06, 188.72] and p < 0.05; odds ratio 0.16 [95% confidence interval, 0.04, 0.72], respectively). No significant difference was exhibited in dehiscence (p = 0.99; odds ratio 0.99 [95% confidence interval, 0.41, 2.38]). Conclusion: In total knee arthroplasty, both barbed and conventional sutures yielded similar results in terms of superficial and deep infection, Hospital for Special Surgery Knee Score, Knee Society Score, and wound dehiscence. Barbed suture was associated with higher incidence of suture breakage, shorter suture time, and less needle stick injury.

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Section: Resultsmentioning

confidence: 99%

A comparison between barbed suture and conventional suture in total knee arthroplasty: a systematic review and meta-analysis

Niu

et al. 2020

Arthroplasty

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confidence: 80%

“…Closure was less expensive and faster in the BSG and there were fewer wound complications (twoin the barbed group vs nine in the traditional group, p=0.03). There was no difference in the rates of needle stick injuries, suture breakage, or glove perforation [4].Chawla compared four groups undergoing unicompartmental knee arthroplasty. These included a group closed with barbed suture for the arthrotomy (Quill) and skin closure (Quill Monoderm), Vicryl for the arthrotomy and Monocryl for the skin, Vicryl for the arthrotomy and staples for skin, and Vicryl for the arthrotomy and Quill Monodermfor the skin.…”

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confidence: 99%

The Use of Barbed Suture for Wound Closure in Hip and Knee Arthroplasty

Solovyova¹

2017

BJSTR

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The increasing number of total joint arthroplasties done on an annual basis, now over one million, along with evolving reimbursement strategies, has helped drive the need for more efficient performance of these cases [1]. This increased the demand for efficiency has led to pursuit of faster, more effective, safer, and cheaper surgical strategies. Soft tissue management is an integral part of total joint arthroplasty and its outcomes. Poor soft tissue handling can lead to dehiscence, infection, and unsightly scars. One of the more recent techniques in wound closure is the use of running barbed suture. The presence of either uni or bidirectional barbs eliminates the need for knots, potentially decreasing the time needed for closure and the number of sutures required and eliminating the gaps between sutures in the layer being closed. This paper summarizes the existing literature pertaining to the use of these suture constructs in total joint arthroplasty.The use of these sutures for closure of the arthrotomy fascia in total knee arthroplasty (TKA) was examined in arandomized controlled trial of 170 patients, performed by Malhotra et al.This included 90 patients in the control group (CG) and 80 in the barbed suture group (BSG). Vicryl and Ethibond (Ethicon Inc, Somerville, NJ) were used for arthrotomy closure in the CG and Quill (Surgical Specialties Corporation, Wyomissing, PA) in the BSG. Vicryl and staples were used in all patients for subcuticular and skin closure in both groups. Wound closure time was four minutes slower and $7.00 more expensive in the CG. There were five needle stick injuries in the CG, compared to zero in the BSG, but there were ten barbed suture breakages and none in the CG. There were no differences in complications or clinical outcomes between the groups [2].Campbell compared the rates of wound complications between 247 TKA wound skin closures performed with Vicryl and staples to 169 wounds closed with running V-Loc (Medtronic, Minneapolis, MN) barbed suture. They found that 18 (7.3%) of the traditional closures and 33 (19.5%) of the barbed suture closures developed wound problems (p<0.001). Additionally, the staple group had a lower rate of eschar formation, but a higher incidence of keloid formation [3]. This suggests that barbed sutures may be problematic for more superficial layers of a surgical closure. A randomized controlled trial performed by Chan compared barbed suture (Stratafix, Ethicon Inc) for both the arthrotomy and skin closure (55 TKAs) and with Vicryl for both (54 TKAs). The Vicryl closure group had higher rates of fluid extravasation upon full flexion. Closure was less expensive and faster in the BSG and there were fewer wound complications (twoin the barbed group vs nine in the traditional group, p=0.03). There was no difference in the rates of needle stick injuries, suture breakage, or glove perforation [4].Chawla compared four groups undergoing unicompartmental knee arthroplasty. These included a group closed with barbed suture for the arthrotomy (Quill) and skin closu...

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“…Although the traditional interrupted suture is considered the standard technique for arthrotomy repair, continuous or running techniques with barbed suture had recently been popular due to the faster closure time, better watertightness, and potential cost reduction [4,30]. However, to the best of our knowledge, no previous studies had established the data related to the e cacy of CLS on the arthrotomy repair and its related outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, the standard technique for arthrotomy repair involves using an interrupted suture with multiple knots with a large-size absorbable braided suture due to the high tensile strength for suture breakage. However, this suture technique is time-consuming and usually creates uneven tension [4]. As an improvement over the interrupted technique, an innovated barbed knotless suture has recently been introduced for the continuous running suture technique, and it has a demonstrated ability to facilitate comparatively faster wound closure time, superior watertight closure, and potentially minor cost reduction [10,19,30].…”

Section: Introductionmentioning

confidence: 99%

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

Wongsak

Chulsomlee

Jarungvittayakon

et al. 2020

Preprint

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Introduction: Medial parapatellar arthrotomy is the standard approach for total knee replacement (TKR) but usually requires adequate arthrotomy repair to allow for early rehabilitation. Nonetheless, no previous studies have clarified the postoperative outcome as quadriceps strength (QS) and functional recovery after using the other simple suture technique for the arthrotomy repair, continuous locking suture (CLS). Methods: 80 patients were randomly assigned into a CLS group (n=40) and an interrupted horizontal mattress (IHM) group (n=40). With the same surgical and rehabilitation protocol, and all arthrotomy repair used only the traditional braided suture. QS was calculated into normalized quadriceps strength (N-QS) and operative leg quadriceps strength compared with contralateral QS (OL-QS). QS, visual analog scale (VAS), modified timed up and go (TUGT) test, Western Ontario and McMasters Universities Osteoarthritis Index [WOMAC] and Knee Society Score [KSS] were followed for 6 months’ period. Results: No significant difference in demographic and perioperative data, except a significant shorter capsular closure time in CLS (233±40 seconds) compared to IHM (388±47 seconds) (p<0.0001). There was no significant difference in N-QS and OL-QS between both groups during the 6-month follow-up period (p>0.05 all). Both groups also did not show any significant difference in the postoperative VAS, TUGT, WOMAC, and KSS (p>0.05 all). Finally, no wound complications or infections manifested during this study. Conclusion: Arthrotomy repair with the CLS technique in TKR and using only the braided suture is safe and effective as demonstrated a recovery of the QS and knee function outcome comparable to the standard IHM technique. Trial registration: This study was registered in Thai Clinical Trials Registry on December 2015 (https://www.clinicaltrials.in.th). The registration number was TCTR20151208003.

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Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomized Controlled Trial

Cited by 64 publications

References 15 publications

A comparison between barbed suture and conventional suture in total knee arthroplasty: a systematic review and meta-analysis

A comparison between barbed suture and conventional suture in total knee arthroplasty: a systematic review and meta-analysis

The Use of Barbed Suture for Wound Closure in Hip and Knee Arthroplasty

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

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