Total Knee Arthroplasty Closure with Barbed Sutures

Eickmann, Tom; Quane, Erika

doi:10.1055/s-0030-1268692

Cited by 51 publications

(39 citation statements)

References 8 publications

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“…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.…”

Section: Discussionsupporting

confidence: 93%

“…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.…”

Section: Discussionsupporting

confidence: 85%

“…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].…”

Section: Discussionsupporting

confidence: 67%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Sah

2015

Clinical Orthopaedics &Amp; Related Research

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Background Effective wound closure is critical to minimizing wound complications and withstanding the forces associated with early knee motion after TKA. Barbed sutures allow for knotless fixation, have been used successfully in other specialties, and may provide for more even distribution of tension along the length of the incision; however, data regarding unidirectional barbed sutures from randomized trials have raised important concerns about their use. Bidirectional barbed sutures offer a potential alternative, but have not been studied extensively in orthopaedic surgery. Questions/purposes Using a prospective, randomized, within-patient controlled study design I compared wound closure performed with bidirectional barbed sutures in one knee of bilateral TKAs performed under the same anesthetic with those performed with standard sutures in the other knee to determine whether the barbed suture was associated with (1) faster closure times; (2) fewer intraoperative suture issues, such as needle sticks or suture breakage, and fewer postoperative wound complications; (3) no detrimental effect on clinical outcomes, including knee ROM and Knee Society scores; and (4) lower total operative cost, considering suture material cost and operating room time savings. Methods Between 2011 and 2012, 50 consecutive patients meeting prespecified inclusion criteria with simultaneous bilateral TKAs had deep and superficial closures performed using interrupted and running standard sutures in one randomly assigned knee, and running knotless bidirectional barbed sutures in the other knee. The barbed suture is US FDA-approved for soft tissue approximation wherever absorbable sutures are appropriate. Intraoperative suture issues and the number of sutures used were recorded at the time of wound closure. Suture cost was compared between the standard and barbed sutures and measured against the operative time cost, as estimated per minute saved. Patients were followed postoperatively at 2, 6, and 12 weeks, and 1 year. Outcomes assessed included detailed operative and tourniquet time, knee ROM, Knee Society scores, postoperative complications, use of antibiotics, and any subsequent surgical interventions. These outcomes were assessed at each visit except for Knee Society scores which were collected at the 12-week and 1-year evaluations. All patients completed followups up to the final evaluation at 1 year. Results Mean wound closure time was 4.7 minutes less using barbed sutures (SD, ± 2.8; 95% CI, À5.5 to À3.7; p \ 0.001), average 16.1 (SD, ± 2.2) versus 11.4 (SD, ± 2.2) minutes for the standard versus barbed suture types,

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Sah

2015

Clinical Orthopaedics &Amp; Related Research

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“…Closure time was faster and cost was lower in the BSG, but there was a higher rate of suture breakage. There were no differences in complications or postoperative functional knee scores [6].…”

Section: Mini Reviewmentioning

confidence: 72%

The Use of Barbed Suture for Wound Closure in Hip and Knee Arthroplasty

Solovyova¹

2017

BJSTR

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The increasing number of total joint arthroplasties done on an annual basis, now over one million, along with evolving reimbursement strategies, has helped drive the need for more efficient performance of these cases [1]. This increased the demand for efficiency has led to pursuit of faster, more effective, safer, and cheaper surgical strategies. Soft tissue management is an integral part of total joint arthroplasty and its outcomes. Poor soft tissue handling can lead to dehiscence, infection, and unsightly scars. One of the more recent techniques in wound closure is the use of running barbed suture. The presence of either uni or bidirectional barbs eliminates the need for knots, potentially decreasing the time needed for closure and the number of sutures required and eliminating the gaps between sutures in the layer being closed. This paper summarizes the existing literature pertaining to the use of these suture constructs in total joint arthroplasty.The use of these sutures for closure of the arthrotomy fascia in total knee arthroplasty (TKA) was examined in arandomized controlled trial of 170 patients, performed by Malhotra et al.This included 90 patients in the control group (CG) and 80 in the barbed suture group (BSG). Vicryl and Ethibond (Ethicon Inc, Somerville, NJ) were used for arthrotomy closure in the CG and Quill (Surgical Specialties Corporation, Wyomissing, PA) in the BSG. Vicryl and staples were used in all patients for subcuticular and skin closure in both groups. Wound closure time was four minutes slower and $7.00 more expensive in the CG. There were five needle stick injuries in the CG, compared to zero in the BSG, but there were ten barbed suture breakages and none in the CG. There were no differences in complications or clinical outcomes between the groups [2].Campbell compared the rates of wound complications between 247 TKA wound skin closures performed with Vicryl and staples to 169 wounds closed with running V-Loc (Medtronic, Minneapolis, MN) barbed suture. They found that 18 (7.3%) of the traditional closures and 33 (19.5%) of the barbed suture closures developed wound problems (p<0.001). Additionally, the staple group had a lower rate of eschar formation, but a higher incidence of keloid formation [3]. This suggests that barbed sutures may be problematic for more superficial layers of a surgical closure. A randomized controlled trial performed by Chan compared barbed suture (Stratafix, Ethicon Inc) for both the arthrotomy and skin closure (55 TKAs) and with Vicryl for both (54 TKAs). The Vicryl closure group had higher rates of fluid extravasation upon full flexion. Closure was less expensive and faster in the BSG and there were fewer wound complications (twoin the barbed group vs nine in the traditional group, p=0.03). There was no difference in the rates of needle stick injuries, suture breakage, or glove perforation [4].Chawla compared four groups undergoing unicompartmental knee arthroplasty. These included a group closed with barbed suture for the arthrotomy (Quill) and skin closu...

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