Skin Staples versus Intradermal Wound Closure following Primary Hip Arthroplasty: A Prospective, Randomised Trial Including 231 Cases

Abstract

Intradermal wound closure is controversial in primary total hip arthroplasty. Randomised, controlled trials in wound closure following a total hip arthroplasty (THA) are scarce. Our hypothesis was that skin staples closure would be related to a similar complication rate and operative time as intradermal closure with polypropylene. From September 2011 to May 2012, 231 THAs in 219 patients with an average age of 62 years old (range: 21-91) were performed. No differences were observed in both groups according to sex, age, BMI and comorbidities (p = 0,82). Cases were divided into 3 groups according to medical factors that influence wound healing: group 1 (no medical history, 70.5%), group 2 (diabetes, tobacco smokers, obesity, corticosteroids, rheumatoid disease, 25%) and group 3 (organ transplantation, neoplastic patients or 2 or factors of group 2, 4.5%). Once randomised using a computer-generated method, all patients remained within the group to which they were allocated to wound closure with skin staples (Leukosan® SkinStapler PTW-35, BSN, Germany) that were used in 112 THAs in 105 patients (48%), or continuous 3.0 intradermal non-absorbable polypropylene suture (Prolene™ 0, Ethicon Inc. Somerville, New Jersey, USA) in 119 THA´s in 115 patients (52%). A 3.8% wound complication rate was observed in this series, with a 2.1% complication rate for the group that was closed with skin staples and a 1.7% rate for the group with intradermal suture (p = 0.7). All the complications were treated conservatively except for one acute deep infection (0.4%) that was successfully treated with debridement, component retention and intravenous antibiotics. There were no differences in both groups related to operative time or wound length.In these series of primary elective THAs, skin staples were associated with a similar complication rate to an intradermal closure technique.

Are Barbed Sutures Associated With 90-day Reoperation Rates After Primary TKA?

“…However, there were no differences in 90-day reoperation rates by surgeon, and most surgeons used both sutures (Table 1). In addition, recent randomized control trials suggest no differences in wound complications when comparing staples with nylon [23] and staples with intradermal sutures in THAs [3]. There may be concerns that more ''difficult'' TKAs were treated with barbed sutures, leading to higher wound complications; however, there were no differences in sutures by preoperative BMI and physical function scores (Table 1), and with only minimal exclusions.…”

Is the Risk of Infection Lower with Sutures than with Staples for Skin Closure After Orthopaedic Surgery? A Meta-analysis of Randomized Trials

“…1) [3, 5, 8, 11, 12, 15-17, 22-24, 26-29, 34, 39]. Six trials included only patients undergoing elective THA or TKA [3,8,12,15,23,39]. Three trials included only trauma patients [16,24,28].…”

“…Nonabsorbable sutures were used in eight studies [3,5,11,15,22,24,29,34] and absorbable sutures were used in five studies [8,12,17,26,28]. Two studies used both suture materials [27,39] (Table 1; Table 4…”

“…These potential risk factors for SSI would suggest the need for adjusted or subgroup analysis; however, they were not performed, thus limiting confidence in the two currently available systematic review and meta-analyses. Furthermore, since the most recent meta-analysis [20], several additional randomized controlled trials (RCTs) have been identified [3,11,15,16,23,26,29]. Consequently, an updated meta-analysis is warranted to assess whether current RCT evidence supports the superiority of staples or sutures for wound closure after orthopaedic surgery, or whether more research is needed before definitive clinical recommendations can be made regarding SSI reduction.…”

Skin closure following fractured neck of femur surgery: a survey of orthopaedic surgeons’ practices

“…Wound complications are a source of morbidity following orthopaedic surgery (2, 3), with persistent wound drainage being strongly correlated with developing deep infection (4). A number of authors have compared clinical outcomes following a variety of hip wound closure methods following elective (5-8) and emergency (9-11) surgery, and other orthopaedic procedures. An appropriately designed and adequately powered study comparing different methods of skin closure following elective hip surgery or specifically related to proximal femoral fracture surgery is lacking in the literature.…”