ReviewWound Closure Techniques for Total Knee Arthroplasty: An Evidence-Based Review of the Literature
Section snippets
Methods
A literature search was conducted using 3 electronic databases: PubMed, EBSCO Host, and SCOPUS. All available studies between 1989 and 2017 were evaluated. Searches were performed using the following terms: arthroplas*[title], knee [title], post-operative outcome [title], complication [title], wound closure [title], suture [title], deep [title], superficial [title], barbed suture [title], staple [title]; adhesive [title]; arthrotomy closure [title], function [title] and closure technique
Deep Closure
Deep or capsular closures are typically performed using either interrupted knotted sutures or more recently continuous barbed sutures. More traditionally, deep closure has been performed using interrupted, knotted sutures. Synthetic, absorbable, braided sutures are often used for deep or arthrotomy closures. In addition, polydioxanone suture is an alternative synthetic absorbable suture that has been used for deep closure. More recently, synthetic absorbable barbed sutures have been developed
Closure Time
Five level I or II studies evaluated the use of barbed sutures in deep and arthrotomy closure in TKA patients [4], [6], [7], [8], [9] (Table 1). Results have been shown to be superior or comparable to standard sutures. When specifically evaluating studies that assess time efficiency, all 5 studies have demonstrated faster closure time with barbed sutures when compared to conventional sutures.
Many studies have shown that barbed sutures allow for faster closure. Gililland et al [6] compared the
Superficial Closure Materials
The superficial layer is defined as the subcuticular and skin tissue. Closure methods for this layer can be broadly divided into 3 materials: sutures (braided, barbed, etc.), staples (traditional and novel), and various types of adhesives. Orthopedists have used these materials individually, as well as in various combinations.
Closure Time
Some studies have demonstrated that when compared to sutures, staples led to a faster mean closure time. Eggers et al [3] conducted a prospective, randomized controlled trial comparing the use of 2 cutaneous adhesives, staples, and sutures in 90 TKA patients. All cohorts had interrupted sutures used for the capsule and subcutaneous layers. Closure time rate was measured by dividing the closure time (in seconds) by the wound length (in centimeters) to control for varying wound sizes. The authors
Newer Closure Techniques
A novel closure system has been recently developed, which uses ultrasonic welding of polymer sutures (Axyaloop; Axya Medical Inc, Beverly, MA) for wound closure. It has been studied in rotator cuff repair and has potential future applications in knee surgery [25]. Similarly, various types of laser welding for wound closure have been developed. These systems utilize wavelength-specific dye absorbers and adhesive proteins such as albumin under temperature control for a fast and efficient wound
Conclusion
Optimal wound closure after TKA would allow for low complication rates, excellent wound healing, acceptable cosmesis, and high postoperative functional scores. Multiple wound closure materials are available for both superficial and deep closure, each with its advantages and disadvantages. In deep closure, barbed sutures have been shown to lead to the fastest closure while providing similar postoperative complications rates to more conventional sutures. In combination with faster surgical time,
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2021, Arthroplasty TodayCitation Excerpt :Second, they do not provide consensus on the methods for use in both knee and hip arthroplasties [2,10]. Third, they focus on adverse events associated with one tissue layer, missing the full picture of multilayer closure [10]. The objective of this study was to conduct a qualitative systematic review of wound closure for hip and knee arthroplasties that characterize the various types of wound closure methods and dressings used in practice, which wound closure methods are used within different tissue layers, and reported rates of adverse events related to wound closure (ie, SSI, deep infection or PJI, prolonged wound drainage, and dehiscence).
Is continuous locking suture with braided suture sufficient for arthrotomy repair in the conventional TKR? A randomized controlled trial study
2021, Journal of OrthopaedicsCitation Excerpt :Notably, though, a few studies have reported an association between the barbed suture and some postoperative complications, such as surgical site infection,11 extensor mechanism repair failure,12 and possible higher risk of reoperation.13 To the best of our knowledge, the evidence for the optimal wound closure has not been clearly developed,14 and the data related to the postoperative outcomes after using other simple suture techniques, such as continuous locking suture (CLS) with braided suture for arthrotomy repair in TKR, has never been published. Therefore, this study aimed to compare the outcome after arthrotomy repair in conventional TKR between the CLS and the standard interrupted suture, in terms of the QS and functional recovery.
Elevated Infection and Complication Rates in Patients Undergoing a Primary THA With a History of a PJI in a Prior Hip or Knee Arthroplasty: A Matched Cohort Study
2020, Journal of ArthroplastyCitation Excerpt :Four patients (4 THAs) in the study population had HHS between 50 and 65 secondary to other musculoskeletal problems (ie, spine degeneration, multiply revised other TJAs, etc). Although PJI after primary THA is uncommon, occurring in just 0.5%-1% of patients, it is a devastating complication for patients and surgeons [2–22]. The number of primary and revision THAs are projected to grow significantly, and the prevalence of patients with a THA is rising [1].
General Assembly, Prevention, Wound Management: Proceedings of International Consensus on Orthopedic Infections
2019, Journal of Arthroplasty
The preparation of this manuscript was partially funded by an educational grant from Ethicon Inc.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2017.09.032.