Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer

Abstract

Background Wound closure is a key, and often underrecognized, component of hip and knee arthroplasty. Methods for wound closure are an important consideration to better avoid wound-related adverse events; however, there is a lack of consensus on optimal methods. The objective of the following review was twofold: to characterize the wound closure methods used by layer in the total knee arthroplasty and total hip arthroplasty literature and summarize optimal wound-healing strategies to address the risk of adverse events. Methods A systematic literature review was performed to identify total knee arthroplasty and total hip arthroplasty randomized controlled trials and nonrandomized studies reporting wound closure methods by layer and wound-healing adverse events (including superficial, deep, or periprosthetic joint infections, wound dehiscence, or prolonged wound drainage). Studies on revision procedures were excluded. Wound closure methods and adverse events were summarized qualitatively as meta-analyses were not possible because of study heterogeneity. Results Forty studies met the inclusion criteria: 22 randomized controlled trials and 18 observational studies. Across studies, 6 categories and 22 unique techniques for closure were identified. Conventional closure methods exhibited large ranges of adverse event rates. Studies of multilayer barbed sutures with topical skin adhesives and polyester mesh or multilayer antimicrobial sutures reported narrow ranges of adverse events rates. Conclusions Considerable variability exists for wound closure methods, with a wide range reported in adverse events. Recent technologies and methods for standardized watertight, multilayer closure show promise for avoiding adverse events and unnecessary health-care costs; however, higher quality, comparative studies are required to enable future meta-analyses. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A comparison of barbed continuous suture versus conventional interrupted suture for fascial closure in total hip arthroplasty

“…Inconsistent application of the barbed sutures during wound closure creates difficulty in comparing the results of these studies. The meta-analysis on these studies 20 , 44 , 45 also has limitations for the heterogeneity of the target studies.…”

Barbed sutures and skin adhesives improve wound closure in hip and knee arthroplasty

“…Notably, conventional closure methods exhibited broad ranges of adverse event rates. In contrast, studies exploring innovative approaches such as multilayer barbed sutures with topical skin adhesives, polyester mesh, or multilayer antimicrobial sutures reported narrower ranges of adverse event rates [16]. This insight highlights the potential benefits of adopting novel techniques in enhancing the predictability and consistency of outcomes in wound closure.…”

“…To date, no definitive evidence exists on the optimal wound closure method for total hip and knee arthroplasty. Consequently, personal preferences and professional experience significantly influence wound management techniques, notably in the choice of closure material [14][15][16]. This document seeks to address this gap by providing surgeons conducting hip and knee arthroplasty with a systematic review of innovative wound closure alternatives, specifically coated barbed sutures and tissue adhesives.…”

Design of biocompatible polylactic acid–polyethylene glycol combination for manufacturing biodegradable staplers

“…Globally, more than 100 million surgical procedures are performed each year. Approximately 50 million of these wounds are traumatized, and 80 percent require enclosure 1,2 …”

“…Approximately 50 million of these wounds are traumatized, and 80 percent require enclosure. 1,2 In terms of wound closure methods, staples, 3 sutures, 4,5 bandages, adhesives strips, 6 hydrogels, 7 and nanofibers can all be considered, each having their advantages and disadvantages. 8,9 For example, suturing non-linear wounds require special expertise, and the outcome is largely determined by the surgeon's expertise.…”