Perioperative Closure-related Complication Rates and Cost Analysis of Barbed Suture for Closure in TKA

Abstract

Background The use of barbed suture for surgical closure has been associated with lower operative times, equivalent wound complication rate, and comparable cosmesis scores in the plastic surgery literature. Similar studies would help determine whether this technology is associated with low complication rates and reduced operating times for orthopaedic closures. Questions/purposes We compared a running barbed suture with an interrupted standard suture technique for layered closure in primary TKA to determine if the barbed suture would be associated with (1) shorter estimated closure times; (2) lower cost; and (3) similar closure-related perioperative complication rates. Methods We retrospectively compared two-layered closure techniques in primary TKA with either barbed or knotted sutures. The barbed group consisted of 104 primary TKAs closed with running barbed suture. The standard group consisted of 87 primary TKAs closed with interrupted suture. Cost analysis was based on cost of suture and operating room time. Clinical records were assessed for closure-related complications within the 6-week perioperative period. Results Average estimated closure time was 2.3 minutes shorter with the use of barbed suture. The total closure cost was similar between the groups. The closure-related perioperative complication rates were similar between the groups. Conclusions Barbed suture is associated with a slightly shorter estimated closure time, although this small difference is of questionable clinical importance. With similar overall cost and no difference in perioperative complications in primary TKA, this closure methodology has led to more widespread use at our institution. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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, when suture costs and time savings are factored in, an overall costs savings of USD 100 to 250 per case with knotless barbed sutures was realized. This is comparable to what has been reported in other studies in which overall costs were calculated [3,4,7,9,11]. In those studies, barbed closures were associated with cost savings between USD 30 and USD 550 per procedure, also in large part attributable to reduced operating time [3,4,7,9,11].…”

“…As with five of the six previously reported studies [2,4,[9][10][11], no differences in intraoperative suture issues or postoperative wound complications were observed in the current study (Table 1). However, to detect differences in rare complications such as dehiscence or infection requires much larger studies than have been conducted to this point.…”

“…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].…”

Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures

“…Several advantages have been claimed for barbed sutures in the literature: Skipping the knotting process allows faster wound closure and can thus be cost saving (in total knee arthroplasty, the average time saved is 2.3 min). 21 As tissue pressure within the knotted constrictive loops rises, it strangulates the tissue, leading to necrosis due to microinfarctions. 22 The resultant inflammatory response and enzymatic tissue degradation decrease the strength of the wound and increase the likelihood of wound dehiscence 23 and infection, as well as the likelihood of wider and unsightly scars.…”