The Role of Barbed Sutures in Wound Closure Following Knee and Hip Arthroplasty: A Review

Abstract

Lower extremity joint arthroplasty procedures often require a large incision to have an adequate exposure, which subsequently leads to lengthy wounds that may contribute to long closure, anesthesia, and overall operative times. The recently introduced knotless barbed suture may provide better outcomes, faster closure time, and decreased material utilization. Therefore, the aim of this study was to review the impact of barbed sutures on: (1) wound-related complications; (2) closure and operative time; (3) patient outcomes (range of motion and Knee Society Scores [KSS]); and (4) effects on cosmesis and patients' satisfaction. A literature search was performed using up to February 2017. Barbed sutures were associated with shorter closure times, shorter operative times, and larger cost savings per procedure as well as comparable wound complication rates after total joint arthroplasty. Although the current review is limited by the number of studies included, it demonstrates that overall, barbed sutures contribute to surgical efficiency when compared with conventional skin closure modalities.

Inpatient versus Outpatient Total Knee Arthroplasty

“…[2][3][4] Perioperative advances including the use of tranexamic acid to decrease blood loss, raising the transfusion criteria, and avoiding the use of Foley catheters have further decreased the need for prolonged hospitals stays. [5][6][7] Within the last 10 years, implementation of bundled payment initiatives has placed an emphasis on decreasing the use of costly acute hospital resources as well as postacute rehabilitation and skilled nursing stays. 8 All of these factors have contributed to the rise in same-day and next-day discharge of TKA patients to home.…”

Evaluation of three methods of suture for skin closure in total knee arthroplasty: a randomized trial

“…Following this prerogative, a shorter time spent closing the skin can be of great help. Gililland et al Reported a significantly shorter closure time with subcuticular suture using Stratafix® compared to single suture [ 10 ], as did other authors [ 16 , 19 , 20 ]. Smith et al found that the use of subcuticular suture starting at the center of the wound and directing to the distal and proximal region of the wound made simultaneously by two professionals is a justification for the shorter closure time with subcuticular sutures with Stratafix® versus traditional unabsorbable sutures.…”

A symmetric anchor designed barbed suture versus conventional interrupted sutures in total knee arthroplasty: A multicenter, randomized controlled trial

“…48 As opposed to conventional sutures' reliance on the knot, barbed sutures, with its knotless design, allow shorter wound closure time, hence possibly reduced infection risk and improved cost-effectiveness. 47 In a meta-analysis of studies on barbed versus conventional sutures, Lin et al concluded that the orientation of the barbs in relation to the needle allows barbed sutures to appose tissues. 12,45,46 It was found that although barbed sutures reduced suture time (standardized mean difference (SMD) ¼ À0.95, 95% CI: À1.43, À0.46, p ¼ 0.0001) and operative time (SMD ¼ À0.28, 95% CI: À0.46, À0.10, p ¼ 0.003), its use increased the incidence of complications (OR ¼ 1.43, 95% CI: 1.05, 1.96, p ¼ 0.03), 12,45,46 but in our study, the incidence of both AEs and SAEs is similar in two group and the use of SADBS did not increase the incidence of complications.…”

“…Like many other surgeries, TKA requires the use of sutures that reduce operating time, wound closure time, and cost, due to the delicate nature of the knee anatomy. 47 TKA requires fast wound closure to reduce superficial and serious infections. Therefore, the use of barbed sutures without knots may be ideal during TKA due to the speed of wound closure.…”