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Flener JL, Chen BPH, Ernst FR, Libolt A, Gunja NJ, Barrett WP. Advanced Multi-Layer Watertight Closure versus Conventional Closure in Total Hip and Knee Replacement Surgery. Pragmat Obs Res 2024; 15:93-102. [PMID: 39049871 PMCID: PMC11268763 DOI: 10.2147/por.s450183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background In total joint replacement procedures, surgeons have increasingly adopted advanced multi-layer, watertight closure. The objective of the study was to compare the clinical and economic outcomes for advanced multi-layer, watertight closure patients to those with conventional closure with sutures and skin staples. Methods Patients aged ≥18 years were included in the study if they underwent total joint arthroplasty of the hip or knee as an elective, primary, inpatient procedure between January 2014 and March 2019. Cohorts having advanced multi-layer, watertight closure or conventional closure were compared using multivariable regression analysis of surgical site infections, length of stay, operating room time, procedure time, discharge status, readmissions, reoperations, and hospital emergency department visits. Results A total of 1828 patients received at least one total hip or knee replacement, of which 434 (23.7%) had advanced multi-layer, watertight closure and 1394 (76.3%) had conventional closure. Unadjusted time to readmission, when occurring, was considerably longer following advanced multi-layer, watertight closure (89.9 vs 51.1 days, p < 0.0001), and a lower proportion of the advanced multi-layer, watertight closure cohort required reoperation within 90 days (0.0% vs 2.6%, p < 0.0001). Adjusted mean hospital length of stay was approximately half of a day shorter for advanced multi-layer, watertight closure patients (1.10 vs 1.65 days; p < 0.001), and they were also more likely to be discharged to home (Odds Ratio: 4.61; p = 0.002). Conclusion Among patients undergoing total hip and knee arthroplasty in a highly optimized real-world clinical practice, advanced multi-layer, watertight closure was associated with significantly shorter inpatient length of stay and increased likelihood of being discharged to home compared with conventional closure. These findings suggest that advanced multi-layer, watertight closure is a valuable component of an optimal workflow for total hip or knee replacement, and may be especially valuable for high-risk patients.
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Affiliation(s)
| | | | - Frank R Ernst
- Real World Evidence and Late Phase, CTI Clinical Trial and Consulting Services, Covington, KY, USA
| | - Aaron Libolt
- Proliance Orthopedic Associates, Renton, WA, USA
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Woelfle CA, Shah RP, Neuwirth AL, Herndon CL, Levine WN, Cooper HJ. 2-Octyl-Cyanoacrylate Mesh Dressings for Total Joint Arthroplasty: Dressing Design Influences Risks of Wound Complications. J Arthroplasty 2024:S0883-5403(24)00650-8. [PMID: 38914145 DOI: 10.1016/j.arth.2024.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Recent liquid adhesive skin closure systems with a mesh patch and a 2-octyl cyanoacrylate liquid formula have shown promising results in total joint arthroplasty. Chemical accelerators are typically included to promote the rapid polymerization of 2-octyl cyanoacrylate. The goal of the study is to distinguish designs and wound complication differences between 2 similar systems. METHODS An 18-week retrospective study was conducted from July to December 2023, including 207 total hip arthroplasty and 212 total knee arthroplasty cases from 4 attending surgeons at 1 institution that used 1 of 2 dressing designs. Both dressings had a 2-octyl cyanoacrylate liquid adhesive formula that applied topically to a polyester-based mesh overlaying the wound. Mesh A (used in 274 cases) included an accelerator, a quaternary ammonium salt, on the mesh patch, whereas Mesh B (used in 145 cases) included a similar accelerator within the adhesive applicator. RESULTS Wound complications (3.2 versus 7.6%; X2 = 3.86; df = 1; P = .049), early periprosthetic joint infections (0 versus 2.8%; X2 = 7.63; df = 1; P = .006), and 90-day reoperations for wound complications (0.4 versus 3.4%; X2 = 6.39; df = 1; P = .011) were significantly lower in patients who received Mesh A versus B, respectively. There was no difference in superficial surgical site infections (0.7 versus 0%; X2 = 1.06; df = 1; P = .302) or allergy rates (3.3 versus 4.1%; X2 = 0.12; df = 1; P = .655) between Mesh A and B. CONCLUSIONS We observed significantly different performance in wound complications, early postoperative periprosthetic joint infections, and 90-day reoperation between the 2 designs. Having the accelerator in the applicator rather than on the mesh patch may lead to premature polymerization before bonding appropriately with the mesh to create the desired wound closure and seal. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Catelyn A Woelfle
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Roshan P Shah
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Oe S, Swamy G, Gagliardi M, Lewis SJ, Kato S, Shaffrey CI, Lenke LG, Matsuyama Y. Wound Closure and Wound Dressings in Adult Spinal Deformity Surgery From the AO Spine Surveillance of Post-Operative Management. Global Spine J 2024:21925682241262749. [PMID: 38869180 DOI: 10.1177/21925682241262749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
STUDY DESIGN An e-mail-based online survey for adult spinal deformity (ASD) surgeons. OBJECTIVE Wound closure and dressing techniques may vary according to the discretion of the surgeon as well as geographical location. However, there are no reports on most common methods. The purpose of this study is to clarify the consensus. METHODS An online survey was distributed via email to AO Spine members. Responses from 164 ASD surgeons were surveyed. The regions were divided into 5 regions: Europe and South Africa (ESA), North America (NA), Asia Pacific (AP), Latin America (LA), and Middle East and North Africa (MENA). Wound closure methods were evaluated by glue(G), staples(S), external non-absorbable sutures (ENS), tapes(T), and only subcuticular absorbable suture (SAS). Wound Dressings consisted of dry dressing (D), plastic occlusive dressing (PO), G, Dermabond Prineo (DP). RESULTS The number of respondents were 57 in ESA, 33 in NA, 36 in AP, 22 in LA, and 16 in MENA. S (36.4%) was the most used wound closure method. This was followed by ENS (26.2%), SAS (14.4%), G (11.8%), and T (11.3%). S use was highest in ESA (44.3%), NA (28.6%), AP (31.7%), and MENA (58.8%). D was used by 50% of surgeons postoperatively. AP were most likely to use PO (36%). 21% of NA used DP, while between 0%-9% of surgeons used it in the rest of the world. CONCLUSION Wound closure and dressings methods differ in the region. There are no current guidelines with these choices. Future studies should seek to standardize these choices.
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Affiliation(s)
- Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ganesh Swamy
- Department of Surgery, Cumming School of Medicine, Calgary, AB, Canada
| | - Martin Gagliardi
- Department of Surgery, Cumming School of Medicine, Calgary, AB, Canada
| | - Stephen J Lewis
- Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Lawrence G Lenke
- Department of Orthopedic Spine Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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Tan Z, Tomaszewski J, Chen BPH, Gunja NJ, Etter K. Use of interrupted time-series analyses in evaluating health economic outcomes following implementation of multilayer water-tight wound closure in a primary total joint arthroplasty population. J Comp Eff Res 2024; 13:e230110. [PMID: 38415342 PMCID: PMC11044954 DOI: 10.57264/cer-2023-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/19/2024] [Indexed: 02/29/2024] Open
Abstract
Aim: Total joint arthroplasty (TJA) with multi-layer, watertight closure (MLWC) using knotless barbed suture and 2-octyl cyanoacrylate plus polymer mesh tape was compared with conventional closure (CC) using Vicryl™ sutures and staples. Patients & methods: Electronic medical records of patients undergoing TJA (1574: total knee arthroplasty; 580: total hip arthroplasty; 13: unknown) from a single surgeon at a US hospital (CC 2011 to 2013; MLWC 2015 to 2020) were reviewed. Outcomes were length of stay (LOS), discharge to skilled nursing facility (SNF), 90-day surgical site infection (SSI) and 90-day readmission. Logistic regression controlled for baseline characteristics. Adjusted interrupted time series (ITS) analyses accounted for decreasing trends in LOS and SNF discharge over time. Results: Among 2167 TJA cases (mean [standard deviation] age 66.0 [9.7] years, 53.3% female), 906 received CC and 1261 received MLWC. Bivariate analysis showed no statistically significant differences in 90-day SSI rates; however, MLWC patients had 60% lower 90-day readmission rates (1.5 vs 3.8%, p < 0.05), 44% lower LOS (1.4 vs 2.5 days, p < 0.05) and 40% lower discharge rates to a skilled care facility (8.5 vs 14.1%, p < 0.05). Multivariable analyses showed CC patients were 2.45-times more likely to be readmitted within 90 days, 1.88-times more likely to be discharged to SNF and had 1.67-times longer LOS compared with MLWC. ITS analyses showed a sharp decline in LOS (0.9 days) and discharge to SNF (5.6% incidence) after implementation of MLWC, followed by no further changes for the remainder of the study period. Conclusion: MLWC was associated with ≥40% reduction in 90-day readmission, LOS and SNF discharge compared with TJA CC. LOS and discharge rate to SNF declined sharply after the implementation of MLWC.
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Affiliation(s)
- Ziyu Tan
- Health Economics & Market Access, Ethicon Inc., Raritan, NJ, USA
| | | | | | | | - Katherine Etter
- Health Economics & Market Access, Ethicon Inc., Raritan, NJ, USA
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Romanini E, Zanoli GA, Ascione T, Balato G, Baldini A, Foglia E, Pellegrini AV, Verde F, Zaffagnini S. Barbed sutures and skin adhesives improve wound closure in hip and knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024; 32:303-310. [PMID: 38318999 DOI: 10.1002/ksa.12055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE This study aimed to formulate evidence-based recommendations for optimising wound management in hip and knee arthroplasty by exploring alternative methods such as barbed sutures and skin adhesives. METHODS A Delphi panel, comprising seven orthopaedic surgeons, one musculoskeletal infectious disease specialist, and one health economics expert, was convened to evaluate the use of barbed sutures and skin adhesives for wound closure in hip and knee arthroplasty. Two systematic reviews informed the development of questionnaires, with panelists ranking their agreement on statements using a 5-point Likert scale. Consensus was achieved if ≥75% agreement. Unresolved statements were revisited in a second round. RESULTS Consensus was reached on 11 statements, providing evidence-based recommendations. The expert panel advocates for a multilayer watertight technique using barbed sutures to prevent surgical site infections (SSI), reduce complications, shorten surgical times, optimise resources and improve cosmetic appearance. For skin closure, the panel recommends topical adhesives to decrease wound dehiscence, enhance cosmetic appearance, promote patient compliance, prevent SSIs, and optimise resources. CONCLUSION The Delphi consensus by Italian total joint arthroplasty experts underscores the pivotal role of barbed sutures and skin adhesives in optimising outcomes. While guiding clinical decision-making, these recommendations are not prescriptive and should be adapted to local practices. The study encourages further research to enhance current evidence. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Emilio Romanini
- RomaPro Centre for Hip and Knee Arthroplasty, Polo Sanitario San Feliciano, Rome, Italy
| | | | - Tiziana Ascione
- Service of Infectious Diseases, AORN A. Cardarelli, Naples, Italy
| | - Giovanni Balato
- Department of Public Health, Federico II University of Naples, Italy
| | | | - Emanuela Foglia
- School of Management Engineering and Healthcare Datascience LAB, Carlo Cattaneo- LIUC University and LIUC Business School, Castellanza, VA, Italy
| | | | | | - Stefano Zaffagnini
- Università di Bologna, Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, Italy
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Mun J, Hyun SJ, Lee JK, An S, Kim KJ. Surgical and Clinical Outcomes Associated With the Use of Barbed Sutures and Self-Adhering Mesh System and Polymeric Glue for Wound Closure in Multilevel or Revision Spinal Surgery: A Matched Cohort Comparative Study With Conventional Wound Closure Procedure. Neurospine 2023; 20:981-988. [PMID: 37798992 PMCID: PMC10562243 DOI: 10.14245/ns.2346534.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Multilevel or revisional posterior spinal surgery is prone to infection and delayed wound healing, related with the wound closure time and suture strength. Knotless barbed suture is an innovative self-locking, multianchor suture. This study aims to evaluate the safety and efficacy of the knotless barbed suture and self-adhering mesh with polymeric glue in multilevel or revisional posterior spinal surgery. METHODS This is a single-center retrospective matched cohort study. Patients were divided into 2 groups based on the wound closure method: barbed suture group with novel wound closure, and conventional suture group with conventional wound closure, 1:1 matched by the level of surgery and sex, resulting in 120 subjects each. Total operation time and wound closure time were measured intraoperatively, and perioperative clinical outcome parameters including postoperative wound complication were investigated for the first 3 months postoperatively. The distribution of continuous variables was assessed for normality by Shapiro-Wilk test, then parametric or nonparametric tests were applied accordingly (paired t-test or Wilcoxon signed-rank test). RESULTS Wound closure time was significantly shorter with the novel barbed suture than with conventional suture in all subgroups divided by the level of spinal surgery: 3-5, 6-9, ≥ 10 levels (p < 0.001). The 2 groups showed no significant differences in surgical complications (p = 1.000). Specially, total operation time and wound-closing time were significantly shorter in revisional subgroup. CONCLUSION Absorbable knotless barbed suture and self-adhering mesh with polymeric glue can shorten spinal wound closure time with noninferiority in complications for multilevel or revisional spinal surgery.
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Affiliation(s)
- Junho Mun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Chen Z, Bains SS, Sax OC, Sodhi N, Mont MA. Dressing Management during Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Knee Surg 2022; 35:1524-1532. [PMID: 36538940 DOI: 10.1055/s-0042-1758674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dressings for total knee arthroplasty (TKA) typically focus on promoting optimal healing, while preventing infection, allowing for functionality and immediate ambulation, while providing for excellent cosmesis. We have previously described four aspects of closure after TKA involving the: (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) a specific aseptic dressing. In this meta-analysis and systematic review of the literature, we will focus on the dressing. Specifically, we assessed: (1) infection risk of different techniques; (2) re-operation or readmission risk; and (3) length of time until dressing change needed. There were 16 reports on infection risk, re-operation risk, and length of time until change needed. A meta-analysis focused on the qualifying wound complication risk reports was also performed. The meta-analysis including four studies (732 patients) demonstrated overall lower wound complication risk with the use of adhesives and mesh dressings (odds ratio 0.67) versus traditional closures. Additionally, studies demonstrated fewer re-operations and readmissions with the use of adhesives and mesh dressings. Furthermore, one report demonstrated mesh dressings persist longer than silver dressings. Therefore, multiple recent reports suggest superior outcomes when using adhesive and mesh dressings for TKAs.
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Affiliation(s)
- Zhongming Chen
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Oliver C Sax
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, North Shore University Hospital Northwell Health, New York, New York
| | - Michael A Mont
- Department of Orthopaedic Surgery, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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8
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Yuan Y, Li J, Wang K, Zheng G, Chai S. The effect of different wound dressing materials used in postoperative treatment of wounds after total hip arthroplasty and total knee arthroplasty: A meta-analysis. Int Wound J 2022; 19:2107-2114. [PMID: 35470964 PMCID: PMC9705168 DOI: 10.1111/iwj.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 12/05/2022] Open
Abstract
A meta‐analysis was performed to assess the effect of different wound dressing materials used in the postoperative treatment of wounds after total hip arthroplasty (THA) and total knee arthroplasty (TKA). A systematic literature search up to January 2022 incorporated 16 trials involving 2765 subjects after THA or TKA at the beginning of the study: 1447 were using active and interactive dressings, and 1318 were using passive dressings. The statistical tools like the dichotomous or continuous method were used within a random or fixed‐influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the influence of different wound dressing materials used in postoperative treatment of wounds after THA and TKA. Active and interactive dressings had significantly lower overall wound complications (OR, 0.32; 95% CI, 0.26–0.40, P < 0.001), number of dressing changes (MD, −1.53; 95% CI, −2.09 to −0.96, P < 0.001), and early dressing change need (OR, 0.14; 95% CI, 0.04–0.47, P = 0.002) compared with passive dressings for subjects after THA and TKA. Active and interactive dressings had significantly lower overall wound complications, the number of dressing changes, and early dressing change need compared with passive dressings for subjects after THA and TKA. Furthermore, evidence is needed to confirm the outcomes.
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Affiliation(s)
- Yingjia Yuan
- Bone Injury Rehabilitation Research Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Jin Li
- Bone Injury Rehabilitation Research Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Ke Wang
- Bone Injury Rehabilitation Research Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Guanqiang Zheng
- Rehabilitation Department, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Shengting Chai
- Joint Center, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
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Robinson J, Smidt KP, Houk G, McKie J, Barton RS, Massey P. Allergic dermatitis after knee arthroscopy with repeated exposure to Dermabond Prineo™ in pediatric patients: Two case reports. World J Orthop 2021; 12:931-937. [PMID: 34888153 PMCID: PMC8613688 DOI: 10.5312/wjo.v12.i11.931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/09/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Allergic contact dermatitis (ACD) secondary to Dermabond Prineo™ is rare, but documented. To our knowledge, there are no described reports of this ACD reaction within the pediatric population following arthroscopic surgery.
CASE SUMMARY We report two cases of pediatric ACD upon second exposure to Dermabond Prineo™ after knee arthroscopy. Both cases presented within two weeks of the inciting second exposure. The cases resolved with differing described combinations of sterile cleaning, diphenhydramine, and antibiotic administration. No long-term sequelae were found.
CONCLUSION This case report elucidates the rare complication of allergic dermatitis secondary to Dermabond Prineo™ repeat exposure use in pediatric arthroscopy.
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Affiliation(s)
- James Robinson
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, LA 71103, United States
| | - Kevin P Smidt
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, LA 71103, United States
| | - Garrett Houk
- School of Medicine, Louisiana State University, Shreveport, LA 71103, United States
| | - Janay McKie
- Department of Orthopaedic Surgery, Shriners Hospital for Children, Shreveport, LA 71103, United States
| | - R Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, LA 71103, United States
| | - Patrick Massey
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, LA 71103, United States
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Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer. Arthroplast Today 2021; 10:180-189.e7. [PMID: 34527801 PMCID: PMC8430424 DOI: 10.1016/j.artd.2021.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/19/2021] [Accepted: 05/16/2021] [Indexed: 01/27/2023] Open
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.
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