A prospective randomised comparison of 2 skin closure techniques in primary total hip arthroplasty surgery

Min, Rui; Zheng, Xin; Sun, Shaosong; Li, Chengyu; Zhang, Xingchen; Guo, Kaijin; Zhao, Fengchao; Pang, Yong

doi:10.5301/hipint.5000534

Cited by 17 publications

(45 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Only one RCT (7.7%) reported significant findings. Rui et al 56 compared staples versus absorbable subcuticular suture for skin closure at a 3-month follow-up in 165 patients. They reported no infections in sutures group versus 2 superficial infections (2.4%) in the staples group.…”

Section: Resultsmentioning

confidence: 99%

Overview of Randomized Controlled Trials in Primary Total Hip Arthroplasty (34,020 Patients): What Have We Learnt?

Matar

Platt

Board³

et al. 2020

JAAOS Glob Res Rev

View full text Add to dashboard Cite

Aim: To provide an overview of randomized controlled trials (RCTs) in primary total hip arthroplasty summarizing the available high-quality evidence. Materials and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), we searched the Cochrane Central Register of Controlled Trials (2020, Issue 1), Ovid MEDLINE, and Embase. We excluded nonrandomized trials, trials on neck of femur fractures or revision surgery, systematic reviews, and meta-analyses. Trials that met our inclusion criteria were assessed using a binary outcome measure of whether they reported statistically significant findings. These were then classified according to the intervention groups (surgical approach, fixation, and component design use, among others). Results: Three hundred twelve RCTs met the inclusion criteria and were included. The total number of patients in those 312 RCTs was 34,020. Sixty-one RCTs (19.5%) reported significant differences between the intervention and the control groups. The trials were grouped into surgical approach 72, fixation 7, cement 16, femoral stem 46, head sizes 5, cup design 18, polyethylene 25, bearing surfaces 30, metal-on-metal 30, resurfacing 20, navigation 15, robotics 3, surgical technique 12, and closure/drains/postoperative care 13 RCTs. Discussion: The evidence reviewed indicates that for the vast majority of patients, a standard conventional total hip arthroplasty with a surgical approach familiar to the surgeon using standard well-established components and highly cross-linked polyethylene leads to satisfactory clinical outcomes. This evidence also offers arthroplasty surgeons the flexibility to use the standard and cost-effective techniques and achieve comparable outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Overview of Randomized Controlled Trials in Primary Total Hip Arthroplasty (34,020 Patients): What Have We Learnt?

Matar

Platt

Board³

et al. 2020

JAAOS Glob Res Rev

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Krishnan

Crawford

Syed

et al. 2019

Clin Orthop Relat Res

View full text Add to dashboard Cite

Background Two previous meta-analyses comparing staples versus sutures have led to conflicting relative risks for surgical site infection between skin closure methods after orthopaedic surgery. Consequently, the choice of sutures or staples for skin closure continues to be a subject of conversation. Recently, additional randomized trials have been published, and an updated meta-analysis is needed to inform this debate. Questions/purposes To determine using a meta-analysis of randomized trials (1) whether there is a difference in surgical site infection (SSI) between staples and sutures for skin closure after orthopaedic surgery, and (2) whether that finding remains the same when the analysis is limited to randomized trials with a low risk of bias. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing staples with sutures for skin closure after orthopaedic surgery was conducted. We excluded barbed sutures, surgical zippers, and skin adhesives from this meta-analysis. Medline, One of the authors (YRR) received personal fees from Medtronic (Minneapolis, MN, USA) outside the submitted work. Each author certifies that his or her institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

show abstract

“…3 In addition to surgical technique and comorbidities, a few studies have evaluated the method of incision closure following THA as a possible risk factor for wound complications. [7][8][9][10][11] The majority of these studies compare staples with either skin adhesive or sutures, but are inconclusive in their results. [7][8][9][10] Furthermore, these studies specifically examine the posterior 11 or lateral approaches, 10 or a combination of anterolateral and posterolateral.…”

mentioning

confidence: 99%

“…[7][8][9][10][11] The majority of these studies compare staples with either skin adhesive or sutures, but are inconclusive in their results. [7][8][9][10] Furthermore, these studies specifically examine the posterior 11 or lateral approaches, 10 or a combination of anterolateral and posterolateral. 8,9 To our knowledge, there is currently no study evaluating incision closure technique as a cause for wound complications following THA via the DAA.…”

mentioning

confidence: 99%

“…[7][8][9][10] Furthermore, these studies specifically examine the posterior 11 or lateral approaches, 10 or a combination of anterolateral and posterolateral. 8,9 To our knowledge, there is currently no study evaluating incision closure technique as a cause for wound complications following THA via the DAA. The methodology of the descriptive studies examining wound complications in DAA either does not mention a closing technique 4 or involves the use of both sutures and staples, with no statistical comparison between the methods.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

et al. 2019

View full text Add to dashboard Cite

A higher rate of wound complications has been reported in the direct anterior approach (DAA) for total hip arthroplasty (THA), reportedly due to the location of the incision and poor surgical site exposure techniques. Therefore, the purpose of this study was to compare wound complications within the first 90 days between a zipper closing method (ZM) and subcuticular monocryl with dermabond skin closure (SMD). A total of 294 patients (352 hips) were closed using the SMD and 166 patients (206 hips) were closed via the ZM. All THAs via the DAA and postoperative care were performed based on the current standard of care for the treatment of symptomatic hip osteoarthritis, established by a single, high volume surgeon from 2016 to 2018. Any wound complications during the first 90 days were noted. Independent t-tests determined differences in descriptive variables. Additionally, a Fisher Exact test was performed to compare wound complication rate between groups (p < 0.05). Surgical time was significantly shorter for ZM (p < 0.001) for both unilateral and bilateral groups compared with SMD. Overall, there were four complications occurring in 558 cases (0.7%), with two cases (0.36%) requiring additional surgery. No wound complications were present in the SMD and four wound complications (1.9%), two requiring surgery, were reported for the ZM (χ2 [1, N = 558] = 6.884, p = 0.009). While no wound complications were reported in the SMD group, the ZM group sustained four wound complications, two of which required additional surgery. Two of these wound complications occurred within the first 14 cases following implementation of the ZM, perhaps indicating a short learning curve. The ZM is a quicker, perhaps easier closure method yet the added expense for materials and suggested increased risk for wound complications may moderate the enthusiasm of the ZM compared with the sutures following THA via the DAA.

show abstract

A prospective randomised comparison of 2 skin closure techniques in primary total hip arthroplasty surgery

Abstract: Closure with running subcuticular suture is cheaper and appears to have a clinical advantage when compared with metallic staples skin closure in primary THA surgery. However, additional operating time may be incurred.

Cited by 17 publications

References 42 publications

Overview of Randomized Controlled Trials in Primary Total Hip Arthroplasty (34,020 Patients): What Have We Learnt?

Overview of Randomized Controlled Trials in Primary Total Hip Arthroplasty (34,020 Patients): What Have We Learnt?

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

Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

Contact Info

Product

Resources

About