Barbed Versus Standard Sutures for Closure in Total Knee Arthroplasty: A Multicenter Prospective Randomized Trial

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

“…In the current study, I found that knee incisions closed with the barbed suture did not differ with the numbers available in Knee Society knee scores or final flexion from those closed with standard sutures. This result is consistent with those of previous reports in which no differences were observed between barbed and standard closure groups in mean degrees of extension and flexion [2], or in the mean total Knee Society knee scores at 6 weeks [3,4]. In the current study, clinical outcomes were excellent regardless of the wound closure method used.…”

“…However, my study does represent a relatively large group of unique within-patient controls, and the comparisons did not show a detriment with use of barbed suture. In the current study, barbed closures were associated with a mean savings of 5 minutes, which is in the range of 3 to 12 minutes reported in other studies with use of this device (Table 1) [2][3][4][9][10][11]. Running knotless closures with barbed sutures consistently are reported to have shorter closure times than standard interrupted closure techniques [2][3][4][8][9][10].…”

“…Well-controlled randomized trials like the current study can help future meta-analyses evaluate this important set of safety questions. To date, the only difference observed in comparing standard with barbed sutures has pertained to intraoperative suture breakage [3]. In the large, prospective, multicenter study by Gililland et al [3], 12 sutures were broken in the barbed closure group (explained as occurring during the learning curve), whereas none were broken in the standard closure group (p \ 0.001).…”

“…To date, the only difference observed in comparing standard with barbed sutures has pertained to intraoperative suture breakage [3]. In the large, prospective, multicenter study by Gililland et al [3], 12 sutures were broken in the barbed closure group (explained as occurring during the learning curve), whereas none were broken in the standard closure group (p \ 0.001). They reported more needle sticks with standard sutures, but the occurrence was not statistically significant.…”

“…This may be partly attributable to a statistically significantly higher frequency of postoperative wound complications reported in two large studies (n = 694 patients) in which closures were performed using the unidirectional barbed suture, V-Loc TM (Covidien, Mansfield, MA, USA) [1,7]; or the three reported occurrences of extensor mechanism repair failure with the bidirectional barbed suture [13]. Most clinical data for the bidirectional barbed suture have been collated from retrospective patient chart reviews [2,3,[9][10][11], with only one large multicenter, prospective study with final skin closure method variation reported to date [3].…”