Is There an Advantage to Knotless Barbed Suture in TKA Wound Closure? A Randomized Trial in Simultaneous Bilateral TKAs

Abstract

Background Effective wound closure is critical to minimizing wound complications and withstanding the forces associated with early knee motion after TKA. Barbed sutures allow for knotless fixation, have been used successfully in other specialties, and may provide for more even distribution of tension along the length of the incision; however, data regarding unidirectional barbed sutures from randomized trials have raised important concerns about their use. Bidirectional barbed sutures offer a potential alternative, but have not been studied extensively in orthopaedic surgery. Questions/purposes Using a prospective, randomized, within-patient controlled study design I compared wound closure performed with bidirectional barbed sutures in one knee of bilateral TKAs performed under the same anesthetic with those performed with standard sutures in the other knee to determine whether the barbed suture was associated with (1) faster closure times; (2) fewer intraoperative suture issues, such as needle sticks or suture breakage, and fewer postoperative wound complications; (3) no detrimental effect on clinical outcomes, including knee ROM and Knee Society scores; and (4) lower total operative cost, considering suture material cost and operating room time savings. Methods Between 2011 and 2012, 50 consecutive patients meeting prespecified inclusion criteria with simultaneous bilateral TKAs had deep and superficial closures performed using interrupted and running standard sutures in one randomly assigned knee, and running knotless bidirectional barbed sutures in the other knee. The barbed suture is US FDA-approved for soft tissue approximation wherever absorbable sutures are appropriate. Intraoperative suture issues and the number of sutures used were recorded at the time of wound closure. Suture cost was compared between the standard and barbed sutures and measured against the operative time cost, as estimated per minute saved. Patients were followed postoperatively at 2, 6, and 12 weeks, and 1 year. Outcomes assessed included detailed operative and tourniquet time, knee ROM, Knee Society scores, postoperative complications, use of antibiotics, and any subsequent surgical interventions. These outcomes were assessed at each visit except for Knee Society scores which were collected at the 12-week and 1-year evaluations. All patients completed followups up to the final evaluation at 1 year. Results Mean wound closure time was 4.7 minutes less using barbed sutures (SD, ± 2.8; 95% CI, À5.5 to À3.7; p \ 0.001), average 16.1 (SD, ± 2.2) versus 11.4 (SD, ± 2.2) minutes for the standard versus barbed suture types,

Comparison of leak pressures for single‐layer simple continuous suture pattern for cystotomy closure using barbed and monofilament suture material in an ex vivo canine model*

“…We did not record the time taken for cystotomy closure since the priority was precise and repeatable closure, not speed. Previous studies measuring the time of suture placement have shown barbed suture is significantly faster to place than conventional suture and we suspect this would translate to cystotomy closure.…”

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

“…P revious research [1,3,7,9,10] has supported many different wound closure techniques for use in TKA including staples, interrupted sutures, running barbed subcutaneous sutures, and subcuticular methods. A midline incision is generally used, but medial and lateral incisions have also been advocated to permit better kneeling ability after surgery or for other reasons [2,6].…”

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

“…There were five premature disengagements and three suture breakages in the CG and none in the BSG. There were no needle stick injuries and no differences in postoperative ROM or outcomes scores [8].…”