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Barbed sutures reduce arthrotomy closure duration compared to interrupted conventional sutures for total knee arthroplasty: a randomized controlled trial

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Background

The broad aim of this study was to compare the safety and efficacy of using barbed sutures versus standard-of-care sutures for closure of arthrotomy during total knee arthroplasty. Specifically, we compared the duration of arthrotomy closure, the number of sutures utilized for arthrotomy closure, and 90-day outcomes, including wound-related readmission, reoperation, and complications.

Materials and methods

A total of 60 patients undergoing primary total knee arthroplasty were enrolled in a prospective, blinded trial and randomized to receive either running closure of the arthrotomy with barbed sutures (n = 30) or interrupted closure with standard-of-care sutures (n = 30).

Results

Arthrotomy closure time was significantly shorter in the barbed suture group (3 min ± 2 min) versus the standard-of-care group (13 min ± 5 min, p < 0.001). The average suture utilization for arthrotomy closure was 1 suture (range 1–2) versus 3 sutures (range 2–4) in the standard-of-care group (p < 0.001). The overall number of wound-related complications in the barbed suture group was 3/30 (10%) versus 3/30 (10%) in the standard-of-care group (p = 1.00). There was one dehiscence 1/30 (3%) in the standard-of-care group versus zero in the barbed suture group (p = 1.00). The rate of superficial surgical site infection was 1/30 (3%) in barbed suture versus zero in the standard-of-care groups (p = 1.00).

Conclusion

These results suggest barbed suture utilization may be faster and more resource-efficient than the use of standard-of-care sutures for arthrotomy closure in primary total knee arthroplasty without increased complications.

ClinicalTrials.gov Identifier

NCT03285529

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References

  1. Krebs VE, Elmallah RK, Khlopas A et al (2018) Wound Closure Techniques for Total Knee Arthroplasty: an Evidence-Based Review of the Literature. J Arthroplasty 33:633–638. https://doi.org/10.1016/j.arth.2017.09.032

    Article  PubMed  Google Scholar 

  2. Khlopas A, Sodhi N, Anis HK, et al (2019) A systematic review of suture technologies in total knee arthroplasty. Surg Technol Int 34

  3. Elmallah RK, Khlopas A, Faour M et al (2017) Economic evaluation of different suture closure methods: barbed versus traditional interrupted sutures. Ann Transl Med 10:12. https://doi.org/10.21037/atm.2017.08.21

    Article  Google Scholar 

  4. Fowler JR, Perkins TA, Buttaro BA, Truant AL (2013) Bacteria adhere less to barbed monofilament than braided sutures in a contaminated wound model. Clin Orthop Relat Res 471:665–671. https://doi.org/10.1007/s11999-012-2593-z

    Article  PubMed  Google Scholar 

  5. Morris MR, Bergum C, Jackson N, Markel DC (2017) Decreased bacterial adherence, biofilm formation, and tissue reactivity of barbed monofilament suture in an in vivo contaminated wound model. J Arthroplasty 32:1272–1279. https://doi.org/10.1016/j.arth.2016.11.010

    Article  PubMed  Google Scholar 

  6. Gingras K, Zaruby J, Maul D (2012) Comparison of V-Loc 180 wound closure device and Quill PDO knotless tissue-closure device for intradermal closure in a porcine in vivo model: evaluation of biomechanical wound strength. J Biomed Mater Res B Appl Biomater 100:1053–1058. https://doi.org/10.1002/jbm.b.32670

    Article  CAS  PubMed  Google Scholar 

  7. Vakil JJ, O’Reilly MP, Sutter EG et al (2011) Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty 26:710–713. https://doi.org/10.1016/j.arth.2010.07.003

    Article  PubMed  Google Scholar 

  8. Nett M, Avelar R, Sheehan M, Cushner F (2011) Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. J Knee Surg 24:55–59. https://doi.org/10.1055/s-0031-1275400

    Article  PubMed  Google Scholar 

  9. Faour M, Khlopas A, Elmallah RK et al (2018) The role of barbed sutures in wound closure following knee and hip arthroplasty: a review. J Knee Surg 31:858–865. https://doi.org/10.1055/s-0037-1615812

    Article  PubMed  Google Scholar 

  10. Zhang W, Xue D, Yin H et al (2016) Barbed versus traditional sutures for wound closure in knee arthroplasty: a systematic review and meta-analysis. Sci Rep 6:19764. https://doi.org/10.1038/srep19764

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Meena S, Gangary S, Sharma P, Chowdhury B (2015) Barbed versus standard sutures in total knee arthroplasty: a meta-analysis. Eur J Orthop Surg Traumatol 25:1105–1110. https://doi.org/10.1007/s00590-015-1644-z

    Article  PubMed  Google Scholar 

  12. Borzio RW, Pivec R, Kapadia BH et al (2016) Barbed sutures in total hip and knee arthroplasty: what is the evidence? A meta-analysis. Int Orthop 40:225–231. https://doi.org/10.1007/s00264-015-3049-3

    Article  PubMed  Google Scholar 

  13. Austin DC, Keeney BJ, Dempsey BE et al (2017) Are Barbed Sutures Associated With 90-day Reoperation Rates After Primary TKA? Clin Orthop Relat Res 475:2655–2665. https://doi.org/10.1007/s11999-017-5474-7

    Article  PubMed  PubMed Central  Google Scholar 

  14. Campbell AL, Patrick DAJ, Liabaud B, Geller JA (2014) Superficial wound closure complications with barbed sutures following knee arthroplasty. J Arthroplasty 29:966–969. https://doi.org/10.1016/j.arth.2013.09.045

    Article  PubMed  Google Scholar 

  15. Smith EL, DiSegna ST, Shukla PY, Matzkin EG (2014) Barbed versus traditional sutures: closure time, cost, and wound related outcomes in total joint arthroplasty. J Arthroplasty 29:283–287. https://doi.org/10.1016/j.arth.2013.05.031

    Article  PubMed  Google Scholar 

  16. Wright RC, Gillis CT, Yacoubian SV et al (2012) Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2011.08.013

    Article  PubMed  Google Scholar 

  17. Sah AP, Levine BR, Sah AP et al (2015) Is there an advantage to knotless barbed suture in TKA wound closure? A randomized trial in simultaneous bilateral TKAs. Clin Orthop Relat Res 473:2019–2027. https://doi.org/10.1007/s11999-015-4157-5

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gililland JM, Anderson LA, Barney JK et al (2014) Barbed versus standard sutures for closure in total knee arthroplasty: a multicenter prospective randomized trial. J Arthroplasty 29:135–138. https://doi.org/10.1016/j.arth.2014.01.041

    Article  PubMed  Google Scholar 

  19. Gililland JM, Anderson LA, Sun G et al (2012) Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res 470:125–129. https://doi.org/10.1007/s11999-011-2104-7

    Article  PubMed  Google Scholar 

  20. Chan VWK, Chan P-K, Chiu K-Y et al (2017) Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomized Controlled Trial. J Arthroplasty 32:1474–1477. https://doi.org/10.1016/j.arth.2016.12.015

    Article  PubMed  Google Scholar 

  21. Healy WL, Della Valle CJ, Iorio R et al (2013) Complications of total knee arthroplasty: standardized list and definitions of the knee society knee. Clin Orthop Relat Res 471:215–220. https://doi.org/10.1007/s11999-012-2489-y

    Article  PubMed  Google Scholar 

  22. Luzzi AJ, Fleischman AN, Matthews CN et al (2018) The “Bundle Busters”: incidence and costs of postacute complications following total joint arthroplasty. J Arthroplasty 33:2734–2739. https://doi.org/10.1016/j.arth.2018.05.015

    Article  PubMed  Google Scholar 

  23. Kurtz SM, Lau EC, Son MS et al (2018) Are we winning or losing the battle with periprosthetic joint infection: trends in periprosthetic joint infection and mortality risk for the medicare population. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.05.042

    Article  PubMed  PubMed Central  Google Scholar 

  24. Eickmann T, Quane E (2010) Total knee arthroplasty closure with barbed sutures. J Knee Surg 23:163–167. https://doi.org/10.1055/s-0030-1268692

    Article  PubMed  Google Scholar 

  25. Malhotra R, Jain V, Kumar V, Gautam D (2017) Evaluation of running knotless barbed suture for capsular closure in primary total knee arthroplasty for osteoarthritis—a prospective randomized study. Int Orthop 41:2061–2066. https://doi.org/10.1007/s00264-017-3529-8

    Article  PubMed  Google Scholar 

  26. Maheshwari AV, Naziri Q, Wong A et al (2015) Barbed sutures in total knee arthroplasty: are these safe, efficacious, and cost-effective? J Knee Surg 28:151–156. https://doi.org/10.1055/s-0034-1373741

    Article  PubMed  Google Scholar 

  27. Kennedy MT, Ong JCY, Mitra A et al (2013) The use of weekly departmental review of all orthopedic intra-operative radiographs in order to improve quality, due to standardized peer expectations and the “Hawthorne effect”. Surgeon 11:10–13. https://doi.org/10.1016/j.surge.2011.10.002

    Article  PubMed  Google Scholar 

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Funding

This study was sponsored by Ethicon, a subsidiary of Johnson & Johnson with an investigator initiated grant. The sponsor had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    K. Sundaram, J. A. Warren, A. Klika, N. S. Piuzzi & V. Krebs

  2. Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, 10075, USA

    M. A. Mont

Authors
  1. K. Sundaram
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  2. J. A. Warren
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  3. A. Klika
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  4. N. S. Piuzzi
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  5. M. A. Mont
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  6. V. Krebs
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Corresponding author

Correspondence to N. S. Piuzzi.

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Conflict of interest

This study was sponsored by Ethicon Corporation. Outside of the submitted work, the following potential conflicts were disclosed: Dr. Krebs reports grants from Ethicon, during the conduct of the study; personal fees from Stryker, personal fees from Stryker Orthopaedics, outside the submitted work; in addition, Dr. Krebs has a patent Stryker issued and Journal of Arthroplasty: Editorial or governing board. Dr. Mont reports personal fees from Cymedica, grants and personal fees from DJ Orthopaedics, grants from Flexion Therapeutics, grants and personal fees from Johnson & Johnson, other from Medicus Works LLC, grants from National Institutes of Health (NIAMS & NICHD), grants and personal fees from Ongoing Care Solutions:, grants and personal fees from Orthosensor, personal fees from Pacira, personal fees and other from Peerwell, personal fees from Performance Dynamics, personal fees from Pfizer, grants and personal fees from Stryker, grants from Tissue Gene, other from Up to Date, other from USMI, other from Wolters Kluwer Health - Lippincott Williams & Wilkins, outside the submitted work; in addition, Dr. Mont has a patent Microport licensed, and a patent Stryker licensed and AAOS: Board or committee member, American Association of Hip and Knee Surgeons: Board or committee member, Journal of Arthroplasty: Editorial or governing board, Journal of Knee Surgery: Editorial or governing board, Knee Society: Board or committee member, Orthopedics: Editorial or governing board, Surgical Techniques International: Editorial or governing board.

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Appendix

Appendix

Closure with the unidirectional barbed suture involves starting proximally and sewing distally. At the ends of the wounds, the suture is backstitched at this subcuticular level (2–3 throws) toward the midpoint for further reinforcement before bringing the needle out through the skin; the suture is then cut flush with the skin tissue at its free end. With each throw, the leading end of the suture is pulled with only enough tension to engage the barbs with the surrounding tissue, thereby locking the wound edges into approximation. As with the traditional closure and in concordance with our routine protocol, barbed closures were finished with skin steri-strips and adhesive.

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Sundaram, K., Warren, J.A., Klika, A. et al. Barbed sutures reduce arthrotomy closure duration compared to interrupted conventional sutures for total knee arthroplasty: a randomized controlled trial. Musculoskelet Surg 105, 275–281 (2021). https://doi.org/10.1007/s12306-020-00654-y

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  • DOI: https://doi.org/10.1007/s12306-020-00654-y

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