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Delgado-López PD, Martín-Alonso J, Herrero-Gutiérrez AI, Martín-Velasco V, Castilla-Díez JM, Montalvo-Afonso A, Diana-Martín R, Pérez-Cabo EM. Barbed versus conventional suture in elective posterior spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2261-2268. [PMID: 38649486 DOI: 10.1007/s00586-024-08224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Barbed sutures are tissue control devices that can reduce operating room time and costs. We analyzed the utility of barbed sutures in posterior spinal surgery in order to prove non-inferiority to conventional methods for wound closure. METHODS A cohort of patients undergoing elective posterior spinal surgery in which barbed (prospective) versus conventional sutures (retrospective) were used was analyzed. The primary endpoint was the occurrence of wound healing complications or the need for surgical revision. Secondary endpoints included postoperative stay, readmission rate, and duration and cost of wound closure. RESULT A total of 483 patients participated in the study, 183 in the Barbed group and 300 in the Conventional group. Wound dehiscence or seroma occurred in 3.8% and 2.7% of the Barbed and Conventional groups, respectively (p = 0.6588). Both superficial (1.6% versus 4.0%, P = 0.2378) and deep infections (2.7% versus 4.7%, p = 0.4124) occurred similarly in both groups. Overall, the rate of re-intervention due to wound healing problems was also similar (4.9% versus 5.3%, p = 0.9906), as well as, total median hospital stay, postoperative stay and 30-day re-admission rates. The average duration of wound closure (1.66 versus 4.16 min per level operated, p < 0.0001) strongly favored the Barbed group. The mean cost of wound closure per patient was higher in the Barbed group (43.23 € versus 22.67 €, p < 0.0001). CONCLUSIONS In elective posterior spinal procedures, the use of barbed sutures significantly reduced the duration of wound closure. The wound healing process was not hindered and the added cost related to the suture material was small.
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Affiliation(s)
- Pedro David Delgado-López
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain.
| | - Javier Martín-Alonso
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | | | - Vicente Martín-Velasco
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - José Manuel Castilla-Díez
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Antonio Montalvo-Afonso
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
| | - Rubén Diana-Martín
- Neurosurgery Department, Hospital Universitario de Burgos, Avda Islas Baleares 3, 09006, Burgos, Spain
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Wang Y, Xu H, Zhao Y, Wang T, Zhou H. Effect of barbed versus standard sutures on wound complications in total knee arthroplasty: A meta-analysis. Int Wound J 2023; 20:4130-4137. [PMID: 37519132 PMCID: PMC10681399 DOI: 10.1111/iwj.14307] [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: 06/17/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
A barbed suture has been demonstrated to be effective in shortening the stitching time and improving the aesthetic appearance of the stitches during the entire knee replacement. However, no meta-analyses have been conducted specifically to evaluate the effect of the barbed thread on wound complications relative to the conventional suture. A comprehensive search of the PubMed database, the Embase database, the Cochrane Library and the Web of Science was performed to obtain search data up to June 2023, and only randomised controlled trials were included in this meta-analysis. We used Review Manager 5.3 for data synthesis and analysis. This meta-analysis included eight studies. It was found that the use of barbed sutures did not improve the incidence of the disease, the infection of the wound, the closure of the abscess and the injury. However, because of the limited sample size of the randomised controlled trials for this meta-analysis, the data should be handled with caution. More high-quality, large-sample studies will be required to confirm the results.
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Affiliation(s)
- Yun Wang
- Department of OrthopedicsShengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch)ShengzhouP.R. China
| | - Hongyu Xu
- Department of OrthopedicsShengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch)ShengzhouP.R. China
| | - Yanghu Zhao
- Department of OrthopedicsShengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch)ShengzhouP.R. China
| | - Tiecheng Wang
- Department of OrthopedicsShengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch)ShengzhouP.R. China
| | - Haidong Zhou
- Department of OrthopedicsShengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch)ShengzhouP.R. China
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Maniar RN, Mody B, Wakankar HM, Sardar I, Adkar N, Natesan R, Paravath SA, Pai S, Mahajan US. Expert Consensus on Best Practices for Optimal Wound Closure in Total Knee Arthroplasty: A STRIDE Initiative for Orthopedic Surgeons of India. Indian J Orthop 2023; 57:2066-2072. [PMID: 38009180 PMCID: PMC10673754 DOI: 10.1007/s43465-023-00922-6] [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: 12/19/2022] [Accepted: 06/02/2023] [Indexed: 11/28/2023]
Abstract
Background Wound closure in joint replacement surgeries is crucial for postoperative rehabilitation. Despite substantial advances in total knee arthroplasty (TKA), no guidelines/recommendation or consensus practice statement available internationally or nationally around the optimal method of wound closure. The study aimed to develop evidence-based consensus on current practices, and proposed adoption of advanced wound closure initiatives. Methods From Nov 2020 to Jan 2021, a group of 12 leading orthopedic surgeons from India met virtually under the Success in Total joint replacement through Recommendation In wounD closure (STRIDE) initiative. Expert committee used Delphi method to evaluate definitional statements that were identified through a comprehensive review of the published literature. Over three rounds of iterative voting, revision, and exclusion, the expert panel provided recommendations based on their clinical expertise and scientific evidence. Statements that reached ≥ 80% agreement was considered as "consensus". A survey poll was conducted following each round to add or suggest changes to the statements. Results General recommendations include marking the arthrotomy before incision, placing the knee in flexion (less than 90°) for re-approximation during arthrotomy closure. The barbed suture can be a good alternative to traditional sutures for providing water-tight capsule closure and topical skin adhesives (TSAs) to staples for minimizing hospital visits and improving patient satisfaction. Conclusion This consensus provides interim guidance and practical references to orthopedic surgeons of India enabling easy access to evidence-based healthcare solutions for TKA wound closure. These recommendations need to be periodically reviewed in light of emerging evidence.
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Affiliation(s)
- Rajesh N. Maniar
- Department of Orthopedics, Lilavati Hospital, Bandra West, Mumbai, Maharashtra 400050 India
| | | | - Hemant M. Wakankar
- Department of Joint Replacement & Reconstruction, Deenanath Mangeshkar Hospital, Pune, Maharashtra India
| | - Indrajit Sardar
- Department of Orthopedics, Nightingale Hospital, Kolkata, West Bengal India
| | - Neeraj Adkar
- Department of Orthopedics, SaiShree Hospital for Special Surgery, Pune, Maharashtra India
| | - Rajkumar Natesan
- Department of Orthopedics, Ganga Hospital, Coimbatore, Tamil Nadu India
| | | | - Sanjay Pai
- Department of Orthopedics, Apollo Specialty Hospital, Bangalore, Karnataka India
| | - Unmesh S. Mahajan
- Department of Orthopedics, Mahajan Ortho and Surgical Hospital, Nagpur, Maharashtra India
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Bellitto NA, Oliver FB, Pollock PJ. Comparison of incisional bursting strength of a bidirectional absorbable knotless suture material versus a standard continuous absorbable suture material for closure of the equine linea alba. Vet Surg 2023; 52:1121-1127. [PMID: 37655506 DOI: 10.1111/vsu.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/23/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To evaluate the use of bidirectional knotless barbed suture material for closure of the equine linea alba. STUDY DESIGN Laboratory study. ANIMAL OR SAMPLE POPULATION Adult light horse cadavers (n = 24). METHODS A 25 cm incision was made through the linea alba, and a 200 L polyurethane bladder was positioned within the abdomen. The linea alba was closed either using USP2/EP5 bidirectional polydioxanone barbed suture or USP2/EP5 standard polydioxanone suture in a simple continuous pattern. Closure time was recorded for each suture type. The bladder was air-insufflated at 40 L/min, and the pressure at body wall failure recorded. The length of suture used for wound closure and wound failure modes were recorded. Suture length, closure time, bursting pressure, and failure modes were compared using Welch-Aspin t-tests. RESULTS The incisional bursting pressure was comparable between the two groups (p > .05). Less suture material (p < .01) was required with the barbed suture than the standard suture. Closure time was less for the barbed suture than the standard suture (p < .01). Suture failure was the main failure mode in both groups (83% cases). CONCLUSIONS Closure of the equine linea alba using bidirectional barbed suture material reduced the amount of foreign material in the wound and decreased closure time without compromising incisional strength. CLINICAL RELEVANCE Bidirectional barbed suture material could be considered as an alternative to standard suture materials for closure of the equine line alba.
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Affiliation(s)
- Nicholas A Bellitto
- Glasgow Equine Hospital & Practice, School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
| | | | - Patrick J Pollock
- Glasgow Equine Hospital & Practice, School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, UK
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Cakmak MF, Horoz L. The Examination of the Benefits of the Usage of Barbed, Knotless Suture in Capsule Repair During Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Study. Indian J Orthop 2023; 57:1881-1890. [PMID: 37881278 PMCID: PMC10593675 DOI: 10.1007/s43465-023-00976-6] [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: 02/21/2023] [Accepted: 08/11/2023] [Indexed: 10/27/2023]
Abstract
Introduction In today's world, high-cost procedures are being examined, and alternative procedures are being developed. In this context, one frequently examined procedure is total knee replacement. Purpose This study aims to examine the three different closure techniques used in total knee replacement. Methods This study is a prospective randomized controlled study. Two hundred participants who underwent total knee replacement surgery, were included in the study. Participants were randomly divided into three groups. Arthrotomy was performed using a medial parapatellar approach with a midline incision. Standard femoral and tibial cuts were followed by the implantation of a Smith and Nephew genesis II implant for all participants. Complications, joint range of motion, pain scores, certain movement degrees, and functional scores were investigated. Results Pre-op and post-op range of motion, knee society score, oxford knee score, certain movement degree values have shown no significant difference. Visual analogue scale values were different significantly between the groups. There is a statistical difference between the range of motion, knee society score, oxford knee score, certain movement degree and visual analogue scale values in repeated measurements. The most common complication was a hematoma. This was observed most frequently in the continuous vicryl suture group. The closure time in the Barbed group was significantly lower than in the other groups. Discussion Treatment for total knee replacement is a heavy economic burden. Health systems and hospitals are under pressure. The results obtained in our study show that there is no superiority of one closure technique over the other.
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Affiliation(s)
- Mehmet Fevzi Cakmak
- Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey
| | - Levent Horoz
- Department of Orthopedics and Traumatology, Kirsehir Ahi Evran University, Kirsehir, Turkey
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Zhang HQ, Xu L, Wang ZL, Shao Y, Chen Y, Lu YF, Fu Z. The effect of reinforcing sutures and trans-anal drainage tube on the outcome of laparoscopic resection for rectal cancer: propensity score‑matched analysis. Langenbecks Arch Surg 2023; 408:289. [PMID: 37515648 DOI: 10.1007/s00423-023-03027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES Laparoscopic resection for rectal cancer is currently the predominant treatment modality for rectal tumors, with an ongoing focus on reducing the incidence of postoperative complications. In an effort to decrease the occurrence of anastomotic leakage, two additional steps worth considering are reinforcing the anastomosis with a barbed suture and retaining an anal drain as part of the procedure. The results of the operation were analyzed by comparing them to cases where the anastomosis was performed with a stapler alone. METHODS This study retrospectively analyzed patients who underwent laparoscopic radical rectal cancer surgery between July 2020 and March 2023. The patients were categorized into three cohorts based on the postoperative management following instrumented anastomosis: cohort A, the instrumented anastomosis alone group; cohort B, the reinforced suture group; and cohort C, the reinforced suture and indwelling transanal drainage tube group. Propensity score matching was performed twice in a 1:1 ratio, comparing cohort B to cohort A and cohort C to cohort B. The objective was to compare the benefits and drawbacks among the different groups in terms of operative time, postoperative outcomes and operative costs. RESULTS 529 patients with laparoscopic resection for rectal cancer were eligible for inclusion. the instrumented anastomosis alone group, reinforced suture group and the reinforced suture and indwelling transanal drainage tube group were performed in 205 patients, 198 patients and 126 patients, respectively. Cohort A and Cohort B differed in three variables after PSM: total operative time (p = 0.018), postoperative hospital stay (p < 0.001) and incidence of anastomotic leakage (p = 0.038). Cohort B had a longer total operative time, shorter postoperative hospital stay and a lower incidence of anastomotic leakage. Similarly, cohort C had less postoperative drainage (P = 0.01) and a longer postoperative hospital stay (P = 0.003) when cohort B and cohort C were matched for propensity scores. There was no significant difference in the cost of surgery between the three cohorts. CONCLUSIONS The incorporation of barbed suture reinforcement significantly reduces the occurrence of postoperative anastomotic leakage in rectal cancer surgeries. On the other hand, although trans-anal drainage was used as an additional measure to the reinforcement suture of the anastomosis, the utilization of trans-anal drainage tubes does not demonstrate a significant improvement in surgical outcomes.
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Affiliation(s)
- Hong-Qiang Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Ling Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Shao
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Chen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun-Fei Lu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zan Fu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Arthrotomy Dehiscence After Total Knee Arthroplasty With a Barbed Suture. J Am Acad Orthop Surg 2023; 31:300-304. [PMID: 36728385 DOI: 10.5435/jaaos-d-22-00539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/18/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Meticulous arthrotomy closure during total knee arthroplasty (TKA) is essential to preserve quadriceps strength and maintain proper patellar tracking. We recently encountered a subset of patients referred with anterior knee pain, a palpable retinaculum defect, and quadriceps weakness. Each patient was found to have an arthrotomy dehiscence. This study highlights arthrotomy dehiscence as a failure mechanism after TKA. METHODS A retrospective case series of patients who underwent primary TKA followed by subsequent capsular dehiscence was reviewed. We investigated whether the dehiscence was related to trauma, the presence of a palpable arthrotomy defect, patellar tracking, quadriceps strength, and the type of closure technique. RESULTS All patients had an atraumatic disruption and presented with anterior knee pain and quadriceps weakness. Fourteen of 18 patients (78%) had a palpable defect along the medial retinaculum. Nine of 18 patients (50%) had patellar subluxation or tilting. Barbed sutures were used in 13 of 18 (72%) patients. A simple arthrotomy repair (44%) or a vastus medialis obliquus advancement (56%) was used successfully in all patients. DISCUSSION Atraumatic arthrotomy dehiscence as a cause of TKA failure historically has been a rare event. Recently, we have noticed a disturbing number of patients presenting with this failure mechanism. With this study, we call attention to this unique atraumatic failure mechanism in patients presenting with anterior knee pain after TKA. Surgeons should be aware of this risk when using barbed sutures alone and should consider routinely reinforcing the arthrotomy with interrupted sutures. LEVEL OF EVIDENCE Level IV, Retrospective Case Series.
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Naylor BH, Tarazi JM, Salem HS, Harwin SF, Mont MA. Wound Management following Total Knee Arthroplasty: An Updated Review. J Knee Surg 2023; 36:274-283. [PMID: 34261158 DOI: 10.1055/s-0041-1731740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.
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Affiliation(s)
- Brandon H Naylor
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - John M Tarazi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - Steven F Harwin
- Department of Orthopaedic Surgery, Mount Sinai West Hospital, New York City, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
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Lakhani A, Khatri K, Malhotra N, Banga R, Bansal D. EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e250368. [PMID: 37082158 PMCID: PMC10112360 DOI: 10.1590/1413-785220233101e250368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/24/2022] [Indexed: 04/22/2023]
Abstract
Introduction Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant. Conclusion Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.
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Affiliation(s)
- Amit Lakhani
- Dr B R Ambedkar State Institute of Medical Sciences, Mohali, Punjab, India
| | - Kavin Khatri
- All India Institute of Medical Sciences, Department of Orthopaedics, Bathinda, Punjab, India
| | - Neeraj Malhotra
- Government Medical College, Department of Orthopaedics, Amritsar, Punjab, India
| | - R.K Banga
- Government Medical College, Department of Orthopaedics, Patiala, Punjab, India
| | - Deepak Bansal
- AIMC Bassi Hospital, Department of Orthopaedics, Ludhiana, Punjab, India
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Matic D, Cheng JS, Gauthier O, Harder Y, Lettieri SC, Chatterjee S, Chen M, Volgas D. Generation of Cross-Specialty Consensus Statements on Soft Tissue Management via a Modified Delphi Method. World J Surg 2022; 46:2174-2188. [PMID: 35831713 PMCID: PMC9334401 DOI: 10.1007/s00268-022-06627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
Background Soft tissue management (STM) training programs for surgeons are largely tradition based, and substantial differences exist among different surgical specialties. The lack of comprehensive and systematic clinical evidence on how surgical techniques and implants affect soft tissue healing makes it difficult to develop evidence-based curricula. As a curriculum development group (CDG), we set out to find common grounds in the form of a set of consensus statements to serve as the basis for surgical soft tissue education. Methods Following a backward planning process and Kern’s six-step approach, the group selected 13 topics to build a cross-specialty STM curriculum. A set of statements based on the curriculum topics were generated by the CDG through discussions and a literature review of three topics. A modified Delphi process including one round of pilot voting through a face-to-face CDG meeting and two rounds of web-based survey involving 22 panelists were utilized for the generation of consensus statements. Results Seventy-one statements were evaluated, and 56 statements reached the 80% consensus for “can be taught as is.” Conclusions Using a modified Delphi method, a set of cross-specialty consensus statements on soft tissue management were generated. These consensus statements can be used as a foundation for multi-specialty surgical education. Similar methods that combine expert experience and clinical evidence can be used to develop specialty-specific consensus on soft tissue handling.
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Affiliation(s)
- Damir Matic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, London Health Science Center, Victoria Hospital, Western University, 800 Commissioners Rd E, London, ON, N6A5W9, Canada
| | - Joseph S Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, P.O. Box 670515, Cincinnati, OH, 45267-0515, USA
| | - Olivier Gauthier
- Department of Small Animal Surgery and Anesthesia, Food Science and Engineering, ONIRIS Nantes-Atlantic College of Veterinary Medicine, Site de la Chantrerie, 101 route de Gachet - CS 40706, 44307, Nantes cedex 3, France
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale Di Lugano, Sede Ospedale Italiano, Ente Ospedaliero Cantonale (EOC), Via Capelli, CH-6962, Viganello - Lugano, Switzerland.,Faculty of Biomedical Sciences, Università Della Svizzera Italiana (USI), Via Buffi 13, 6900, Lugano, Switzerland
| | - Salvatore C Lettieri
- Division of Plastic Surgery, Mayo Clinic, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Sandipan Chatterjee
- AO Education Institute, AO Foundation, Stettbachstrasse 6, 8600, Dübendorf, Switzerland
| | - Maio Chen
- AO Innovation Translation Center, AO Foundation, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - David Volgas
- Department of Orthopaedic Surgery, University of Missouri - Columbia, 3800 S National Ave Suite 600, Springfield, MO, 65807, USA
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Shi K, Chen X, Shen B, Luo Y, Lin R, Huang Y. The use of novel knotless barbed sutures in posterior long-segment lumbar surgery: a randomized controlled trial. J Orthop Surg Res 2022; 17:279. [PMID: 35585558 PMCID: PMC9118583 DOI: 10.1186/s13018-022-03165-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background The study carries the aim to compare the clinical efficacy and economic outcomes of using barbed suture closure versus conventional closure for wounds after posterior long-segment lumbar surgery. Methods One hundred and eighty-one patients undertaking posterior long-segment lumbar surgery participated in the prospective randomized controlled trial study to receive either barbed suture wound closure (n = 91) or conventional suture closure (n = 90). Outcome measures included operating room time (ORT), wound closure time, length of incision, length of hospital stay (LOS), 90-day readmission rates, wound complications of dehiscence and infection, and costs. Results Barbed suture group was related with significantly lower ORT (P = 0.036), wound closure time (P < 0.001) and average wound closure time (P < 0.001), and significantly lower wound complication rates (dehiscence and infection) (P = 0.031). No significant differences were found when compared with conventional suture group in terms of length of incision (P = 0.086), length of hospital stay (P = 0.174), readmission rates up to 90 days after the surgical procedure (P = 0.232) and costs (P = 0.205). Conclusion The study suggested the knotless barbed suture technique outperformed the conventional suture in shortening operating room time, wound closure time and average wound closure time, and reducing wound complication rates.
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Affiliation(s)
- Kai Shi
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Rd., Taijiang District, Fuzhou, 350005, Fujian Province, China
| | - Xuanwei Chen
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Rd., Taijiang District, Fuzhou, 350005, Fujian Province, China
| | - Bin Shen
- School of Foreign Languages, Fuzhou University, No. 2 Xueyuan Rd, University Town, Fuzhou, 350004, Fujian Province, China
| | - Yue Luo
- Fujian Medical University, No. 88 Jiaotong Rd., Taijiang District, Fuzhou, 350005, Fujian Province, China
| | - Renqin Lin
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Rd., Taijiang District, Fuzhou, 350005, Fujian Province, China
| | - Yu Huang
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Rd., Taijiang District, Fuzhou, 350005, Fujian Province, China.
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Barbed Sutures for Total Hip and Knee Arthroplasty Have Shorter Wound Closure Time and are Cost-Effective in Comparison to Traditional Sutures: A Systematic Review and Meta-analysis of 16 Randomized Controlled Trials. Indian J Orthop 2022; 56:1156-1173. [PMID: 35813548 PMCID: PMC9232689 DOI: 10.1007/s43465-022-00638-z] [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: 08/19/2021] [Accepted: 04/02/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical wound closure is of paramount importance, especially in total joint replacement surgeries wherein correct closure technique not only aids in rapid healing, but with lesser complications, we would be looking at a quicker rehabilitation of the patients. Bidirectional barbed sutures appear to reduce the wound closure time in all the planes and are cost-effective in comparison with traditional sutures. This study is aimed at evaluating the efficacy and superiority of bidirectional barbed sutures in comparison to traditional suturing techniques. METHODS Electronic databases like Embase, PubMed, Cochrane Library, Lilacs were searched up to February 2021. 16 high-quality randomized-controlled trials (RCT) were selected in this study. The search method identified 2168 total knee replacements (TKR) and 229 total hip replacements (THR) among 2397 patients. All the studies compared barbed sutures with traditional wound closure techniques. Data of wound closure time, overall cost, length of hospital stay, overall wound complications, suture-related complications, range of motion data, and knee society scores were collected and further analyzed. RESULTS The baseline patient characteristics were identical among all the included studies. Compared to traditional sutures a significantly decreased wound closure time in both THR and TKRs (p < 0.00001) and cost (p < 0.00001) was noted, although no statistically significant difference was found in overall complications in THRs (p = 0.95) and TKRs (p = 0.69). ROM (p = 0.54-6 weeks after surgery and p = 0.68-3 months after surgery) and Knee society scores (p = 0.92) in both the groups of patients undergoing TKR. However, the length of hospital stay was prolonged in the barbed suture group (p = 0.01), pinpricks (p = 0.02), and broken sutures (p = 0.02). CONCLUSIONS Novel methods of wound closure such as barbed sutures achieve satisfactory surgical implementation being more efficient in the form of decreasing the overall wound closure time, with comparable wound complication rates and being cost-effective. But the drawbacks like the incidence of broken sutures and pinpricks are more. Overall using barbed sutures in place of traditional sutures may be considered safe and a viable alternative choice for suturing in total joint replacements. LEVEL OF EVIDENCE Level I, Systematic review and Meta-analysis of RCT.
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The impact of novel anchored barbed suture for capsular closure on hospital length of stay after total knee arthroplasty: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:349. [PMID: 35410234 PMCID: PMC8996641 DOI: 10.1186/s12891-022-05292-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Objective The aim was to evaluate whether using novel anchored barded suture for capsular closure can further shorten the length of stay following primary total knee arthroplasty (TKA) within existed enhanced recovery after surgery (ERAS) protocol in osteoarthritis patients. Methods A retrospective cohort study was conducted among osteoarthritis patients aged 18 to 80 years without major comorbidities who underwent primary unilateral TKA between January 2018 and December 2019 was conducted. The capsular closure techniques, interventions for ERAS, operation time and length of stay were collected via hospital electronic information system. Propensity-score matching was used to compensate for the difference in interventions for ERAS and patient characteristics. Subgroup comparison of patients treated under normal ERAS protocol was performed. Results Included were 315 patients with capsular closure by barded suture and 397 patients with interrupted capsular closure by traditional suture. Patients’ characteristics and interventions for ERAS were balanced after propensity-score matching. The average postoperative length of stay in barded suture group was shorter than the compared group (2.10 ± 0.57 vs. 2.33 ± 0.80 days, p = 0.004), and with a significantly higher proportion of patients discharging within 2 days post procedure (88.0% vs. 70.7%, p < 0.001). The operation time for patients with barded suture closure was shorter compared to interrupted closure technique (100.90 ± 16.59 vs. 105.52 ± 18.47 min, p = 0.004). Subgroup analysis of patients treated under different levels ERAS protocol showed comparable results. Conclusion The use of barded suture for capsular closure was associated with shorter length of stay after TKA compared to traditional suture, suggesting that barded suturing technique could be one effective intervention for ERAS. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05292-y.
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A comparison of barbed continuous suture versus conventional interrupted suture for fascial closure in total hip arthroplasty. Sci Rep 2022; 12:3942. [PMID: 35273233 PMCID: PMC8913744 DOI: 10.1038/s41598-022-07862-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
A barbed suture is a self-anchoring knotless suture hypothesized to shorten suture time and reduce the tension point of the wound. The purpose of this study was to compare the barbed suture and the interrupted suture for fascial closure in total hip arthroplasty. We retrospectively reviewed patients who underwent total hip arthroplasty from March 2014 to June 2020. We evaluated 324 cases among 274 patients consisting of 188 males and 86 females. We collected the following data: demographics, time for wound closure, the number of threads used, hemoglobin level, surgical site pain, and wound complications. Variables were analyzed for their association with closure time using multiple regression analyses between the barbed suture (the SFX group) and the interrupted suture (the Vicryl group). Mean closure time was 5.8 min lower and the mean number of sutures used was 2.2 lower in the SFX group versus the Vicryl group (P < 0.01 and < 0.01, respectively). There were no statistical intergroup differences in the mean largest hemoglobin drop, the incidence of transfusion, surgical site pain, and the incidence of wound complications. The use of barbed sutures for fascial closure in total hip arthroplasty effectively reduces the surgical time without increasing wound complications.
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Li E, Zhang T, Ma Q, Yan K, Zhang X, Wang W, Liao B. Effect of Modified Allgöwer-Donati Suture Technique on Wound Cosmetics in Spinal Surgery. Orthop Surg 2022; 14:678-685. [PMID: 35179312 PMCID: PMC9002073 DOI: 10.1111/os.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To analyze the efficacy of modified Allgöwer–Donati suture (MADS) technique on cosmetic outcomes compared with vertical mattress suture (VMS) technique in spinal surgery wounds. Methods This randomized controlled trial was conducted at the First Hospital of Lanzhou University (Gansu, China) from September 2019 to August 2020. The patients were randomly divided into two groups, a VMS group and a MADS group, by staff not involved in the treatment using a computer‐based random number table program (no restrictions on age or sex). Both procedures were performed by the same group of physicians as well as assistants. All suture wounds were completed by the same person. The primary endpoint was the scar area, and the postoperative scar area was scored by the Patient and Observer Scar Scale Assessment (POSAS). The scar area was calculated by ImageJ software. The second outcome measure was wound complications, including poor wound healing, wound edge necrosis, and infection. The trial was recorded in the Chinese Clinical Trial Register on 18 August 2019 (ChiCTR1900024548). Results A total of 143 patients were included: 72 in the VMS group and 71 in the MADS group. There was no significant difference in their demographics in terms of age (49.71 ± 8.91 vs 50.15 ± 6.79 years, P = 0.737), sex (M/F, 30/41 vs 31/41, P = 0.923), suture time (3.39 ± 0.22 vs 3.47 ± 0.25 s/mm, P = 0.057), or body mass index (BMI, 23.88 ± 3.50 vs 24.05 ± 3.50, P = 0.765) for MADS to VMS. The postoperative scar area was compared between the two groups transversely on day 12, the MADS wound scars decreased by 58.95% (75,133.24/127,452.58). In the POSAS evaluation, after MADS treatment, surface area score decreased from 5 (4, 5) to 2 (2, 3) (P < 0.0001), observer's overall opinion from 5 (4, 5) to 3 (2, 3) (P < 0.0001), itching from 3 (3, 4) to 3 (2, 3) (P = 0.001), color from 4 (4, 5) to 3 (2–4) (P < 0.0001), stiffness 4 (3–4.75) to 3 (3, 4) (P < 0.0001), or thickness from 4 (3–5) to 4 (3, 4) (P = 0.004). In terms of overall opinion evaluation, the MADS showed a significant difference in observer's overall opinion to the VMS (5 (4, 5) vs 3 (2, 3), P < 0.0001) and in patient's overall opinion 5 (5, 6) to 3 (3, 4), (P < 0.0001). There was no significant statistical difference in poor wound healing (3 vs 0, P = 0.245), wound edge necrosis (3 vs 0, P = 0.245), and infection (1 vs 0, P = 1.000) with the MADS to the VMS. Conclusion The results of this study show that the MADS effectively reduced the surgical scar area to 58.95% with no additional adverse events compared with that of the VMS in spine surgery.
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Affiliation(s)
- Erliang Li
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Tong Zhang
- Department of Orthopedics, The First Affiliated Hospital of Lanzhou University, istrict, Lanzhou, China
| | - Qiong Ma
- Orthopaedic Oncology Institute, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Kang Yan
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Xueliang Zhang
- Department of Orthopedics, The First Affiliated Hospital of Lanzhou University, istrict, Lanzhou, China
| | - Wenji Wang
- Department of Orthopedics, The First Affiliated Hospital of Lanzhou University, istrict, Lanzhou, China
| | - Bo Liao
- Department of Orthopedics, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
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Zhou Y, Chen J, Dong X. Impact of Whole-Layer Barbed Suture Closure on the Postoperative Effect and Aesthetic Satisfaction with Incision After Knee Arthroplasty. Patient Prefer Adherence 2022; 16:2041-2049. [PMID: 35975174 PMCID: PMC9375971 DOI: 10.2147/ppa.s365143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effect of whole-layer barbed suture for incision closure on the clinical outcome and aesthetic satisfaction of patients with the incision following total knee arthroplasty (TKA). MATERIALS AND METHODS A retrospective analysis was conducted on 94 patients (37 men and 57 women, 50-84 years old) who underwent a first TKA between May 2018 and April 2021. The enrolled patients were divided into two groups according to the suture mode, with 45 cases (group A) receiving closure of the deep tissue with a barbed suture and intradermal suture of the incision with another barbed suture and 49 cases (group B) receiving closure of the deep tissue with absorbable suture and interrupted suture of the incision with nonabsorbable suture. Further comparisons were performed regarding incision length, suture time, postoperative incision complications, Hollander Wound Evaluation Score (HWES), Hospital for Special Surgery (HSS) knee score, American Knee Society (AKS) score, and Patient and Observer Scar Assessment Scale (POSAS). The clinical effects of the two suture modes in TKA and the patients' aesthetic satisfaction with the incision were also evaluated at 2 weeks, 3 months and 6 months after the operation. RESULTS Compared with group B, group A had higher HWES at 2 weeks after the operation (P < 0.05), shorter suture times (P < 0.05) and lower POSAS scores at 3 and 6 months after the operation (P < 0.05). However, no significant difference was observed between the two groups in incision length, complication rate, HSS or AKS scores (P > 0.05). CONCLUSION Compared with the interrupted suture, the use of whole-layer barbed suture for incision closure after TKA has the advantages of a safe and effective outcome, short operation time, high cosmesis degree of the wound scar and high patient satisfaction.
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Affiliation(s)
- Yongchun Zhou
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Jing Chen
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - XiangHui Dong
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
- Correspondence: XiangHui Dong, Department of Orthopedic, Shaanxi Provincial People’s Hospital, 256 You-yi West Road, Xi’an, Shaanxi, 710068, People’s Republic of China, Email
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Sun C, Chen L, Du R, Wu S, Ma Q, Cai X. Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials. J Knee Surg 2021; 34:1516-1526. [PMID: 32462647 DOI: 10.1055/s-0040-1710373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to August 2019. Finally, we identified 1,472 TKAs (1,270 patients) assessed in 13 randomized-controlled trials. Compared with conventional wound closure techniques, barbed sutures resulted in shorter total wound closure time (p < 0.001), fewer needle puncture injuries to members of the surgical team (p = 0.02). There were no significant differences in terms of blister formation (p = 1.0), superficial infection (p = 0.82), range of motion (p = 0.94), incisional exudate (p = 0.75), suture abscess (p = 0.26), or suture breakage (p = 0.11), wound-related complications (p = 0.10), ecchymosis (p = 0.08) between barbed and conventional wound closure. Based on the available level I evidence, we thus conclude that a knotless barbed suture is a safe and effective approach for wound closure in TKA. Given the relevant possible biases in our meta-analysis, more adequately powered and better-designed randomized-controlled trials studies with long-term follow-up are required to recommend barbed sutures for routine administration in TKA.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Lianxu Chen
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Ruiyong Du
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Sha Wu
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Qi Ma
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
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Fillingham YA, Matonick JP, Mendoza V, Parvizi J. Comparing the Water-Tight Closure of Barbed and Conventional Suture Under Static and Dynamic Conditions in an Ex-Vivo Human Knee Arthrotomy Model. Arthroplast Today 2021; 12:1-6. [PMID: 34703862 PMCID: PMC8526417 DOI: 10.1016/j.artd.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background Barbed suture has become popular for closure of the arthrotomy and overlying tissues in total knee arthroplasty. STRATAFIX Symmetric PDS Knotless Tissue Control Device, a unique and novel barbed suture, with barbs formed integral to the suture core provides greater suture strength than the more common cut barbed suture designs. It is the only barbed suture commercially available with an indication in high tension areas, such as fascia. The purpose of this study was to evaluate the use of this novel barbed suture in the formation of a water-tight arthrotomy closure, using a continuous suture pattern, compared to conventional Coated VICRYL (polyglactin 910) Suture, using an interrupted suture pattern, in a cadaveric knee arthrotomy. Methods Twenty fresh-frozen cadaver knees underwent randomization to provide donor-paired matching of the knee arthrotomy closures using barbed suture in a continuous pattern or conventional suture in an interrupted pattern. Each specimen underwent 5 phases of testing that included 1) predynamic static leak testing; 2) dynamic motion leak testing; 3) postdynamic static leak testing; 4) suture release static leak testing; and 5) postsuture release dynamic motion leak testing, to assess the fluid leak rate. Results Under the initial static conditions, watertightness was similar for the 2 types of sutures. However, in all subsequent phases of testing, continuous barbed suture created a better watertight closure than interrupted conventional suture. Conclusions In this study, it was observed that closure of a knee arthrotomy using the novel barbed suture provided improved watertightness compared to conventional interrupted closure under dynamic conditions and suture release.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - John P Matonick
- Department of Preclinical Research, Ethicon Inc, Somerville, NJ, USA
| | - Vivienne Mendoza
- Department of Preclinical Research, Ethicon Inc, Somerville, NJ, USA
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Herndon CL, McCormick KL, Gazgalis A, Bixby EC, Levitsky MM, Neuwirth AL. Fragility Index as a Measure of Randomized Clinical Trial Quality in Adult Reconstruction: A Systematic Review. Arthroplast Today 2021; 11:239-251. [PMID: 34692962 PMCID: PMC8517286 DOI: 10.1016/j.artd.2021.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/08/2021] [Accepted: 08/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence Level I; Systematic Review.
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Affiliation(s)
- Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Kyle L McCormick
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Anastasia Gazgalis
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Elise C Bixby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Matthew M Levitsky
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander L Neuwirth
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Sah AP. A Prospective, Randomized Evaluation of the Quality of Wound Closure With Barbed Versus Standard Suture After Total Joint Arthroplasty. Orthopedics 2021; 44:216-222. [PMID: 34292819 DOI: 10.3928/01477447-20210621-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Complications such as joint infection or delayed wound healing can lead to morbidity and elevated health care costs after total joint arthroplasty. The purpose of this study was to compare the quality of running knotless barbed suture vs standard monofilament suture wound closure with respect to wound drainage and healing complications after total joint arthroplasty. For this study, 1000 joint arthroplasty patients were prospectively randomized to have fascial, soft tissue, and skin closure with knotless barbed suture vs standard suture during the period 2016 to 2018. An absorptive dressing was used for 1 week postoperatively. Each dressing was weighed and the saturated surface area of the dressing measured. A total of 939 dressings were available for evaluation. Incisions were evaluated for wound healing at each postoperative visit. Of the 1000 joint arthroplasties performed, suture breakage or needle disengagement occurred similarly with the standard monofilament suture and the running barbed suture (13 times vs 6 times; P=.17). Dressings were weighed, and when standard monofilament sutures were used, an average of 1.2 g more postoperative bandage weight was recorded (P<.002). Postoperative wound complications including stitch abscess or wound irritation occurred more often with standard monofilament sutures than with running barbed sutures (16 times vs 5 times; P<.025). Optimal wound closure after joint replacement is critical to enhance soft tissue healing and minimize infection risk, which can be caused by excessive wound drainage. The positive results shown for the running barbed suture of this prospective study indicate the difference in quality of closure between the standard monofilament suture and the running barbed suture in hip and knee arthroplasty surgical sites. [Orthopedics. 2021;44(4):216-222.].
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21
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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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22
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Vieira RB, Waldolato G, Fernandes JS, de Carvalho TG, Moreira PAM, Moreira GB, Vieira JS. Evaluation of three methods of suture for skin closure in total knee arthroplasty: a randomized trial. BMC Musculoskelet Disord 2021; 22:747. [PMID: 34461886 PMCID: PMC8406602 DOI: 10.1186/s12891-021-04627-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are several studies comparing techniques and different materials, yet the results are not unanimous. We compared three methods of skin closure in total knee arthroplasty (TKA), including suture with single stitches and unabsorbable MonoNylon®, as well as continuous subcuticular suture with Monocryl® or barbed Stratafix® absorbable suture. METHODS A prospective, randomized study was conducted with 63 patients undergoing TKA between March 2016 and December 2016. Patients were divided into three groups: traditional suture MonoNylon® (n 22), subcuticular continuous suture with Monocryl® (n 20), and another barbed with Stratafix® (n 21). The closure time, length of wire used, pain intensity, possible complications, and cosmeses were evaluated. RESULTS Subcuticular continuous suture using Monocryl® was superior to traditional suture using MonoNylon® as less thread was used (p 0.01) and a better cosmetic effect was achieved (p < 0.01), which was equal to Stratafix® aspects analyzed (p > 0.05). Complications were observed mostly in patients who used Stratafix®. CONCLUSIONS This study concluded that the subcuticular suture with absorbable monofilament Monocryl® proved to be advantageous compared to the others because it presented results equal to the barbed Stratafix®, however with fewer complications. Furthermore, Monocryl® was shown to be equal or superior to traditional MonoNylon® suture regarding in relation pain intensity, aesthetic result, and effective cost. TRIAL REGISTRATION WHO ICTRP identifier RBR78dh5d. Retrospectively registered: 07/29/2020.
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Affiliation(s)
- Rodrigo Barreiros Vieira
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil
| | - Gustavo Waldolato
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil.
| | - João Sequeira Fernandes
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil
| | - Thiago Gontijo de Carvalho
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil
| | - Pedro Augusto Maciel Moreira
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil
| | - Guilherme Barbosa Moreira
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil
| | - Jorge Suman Vieira
- Department of Orthopaedics, Hospital Universitário Ciências Médicas-Faculdade de Ciências Médicas de Minas Gerais, Rua dos Aimorés, 2896- Santo Agostinho, MG 30140-073, Belo Horizonte, Brazil
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Wang W, Yan S, Liu F, Chai W, Zuo J, Xiao J, Niels-Derrek S, Zhu Q, Sanghita B, Bogdan I, Wang K. A symmetric anchor designed barbed suture versus conventional interrupted sutures in total knee arthroplasty: A multicenter, randomized controlled trial. J Orthop Surg (Hong Kong) 2021; 28:2309499020965681. [PMID: 33267734 DOI: 10.1177/2309499020965681] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This randomized controlled study was designed to compare the wound closure efficacy and safety of barbed suture in comparison to the conventional interrupted suture for total knee arthroplasty (TKA). METHODS This multicenter, single-blind, randomized controlled trial enrolled 184 patients who underwent elective TKA between June 2017 and April 2018. The subjects were randomized between two groups. Surgical incision closure time was considered as the primary end point. RESULTS A total of 184 patients participated in this randomized controlled trial; 91 patients had wound closure that involved barbed suture and 93 patients underwent conventional treatment-that is interrupted suturing with nonbarbed sutures. The surgical incision closure time was shorter (p < 0.0001) in the barbed suture group compared with the control group (15.5 ± 4.88 vs. 20.9 ± 6.30 min). However, both groups were found to be equal in terms of the rate of postoperative complications. CONCLUSION Usage of the symmetric anchor designed barbed suture is safe, efficacious, and demonstrates a decrease in surgical incision closure time in patients undergoing TKA compared to interrupted closure using conventional sutures. Future studies are warranted to demonstrate clinical and economic benefits of barbed sutures.
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Affiliation(s)
- Wei Wang
- Department of Orthopedics, Second Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shigui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Liu
- Department of Orthopedics, Jiangsu Province Hospital, Nanjing, China
| | - Wei Chai
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jun Xiao
- Department of Orthopedics, Tongji Hospital, Wuhan, China
| | | | - Qing Zhu
- Ethicon Inc., Somerville, NJ, USA
| | | | | | - Kunzheng Wang
- Department of Orthopedics, Second Hospital of Xi'an Jiaotong University, Xi'an, China
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Is continuous locking suture with braided suture sufficient for arthrotomy repair in the conventional TKR? A randomized controlled trial study. J Orthop 2021; 24:47-53. [PMID: 33679027 PMCID: PMC7907677 DOI: 10.1016/j.jor.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/07/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Medial-parapatellar-arthrotomy is the standard approach for total knee replacement(TKR). No studies have clarified the outcomes as quadriceps-strength-recovery (QS) and safety of Continuous-locking-suture-technique(CLS) for the arthrotomy-repair. Methods Patients were randomly assigned into a CLS(n = 40) and an interrupted-horizontal-mattress(IHM, n = 40). QS, visual-analog-scale(VAS), modified-timed-up-and-go(TUGT) test, Western-Ontario-and McMasters-Universities-Osteoarthritis-Index[WOMAC] and Knee-Society-Score[KSS] were followed for 6 months’. Results A significantly-shorter capsular-closure-time in CLS(233 ± 40 VS 388 ± 47 sec)(p < 0.0001). There were insignificant difference in QS, VAS, TUGT, WOMAC and KSS during the 6-month follow-up period(p > 0.05 all). No wound complications were found. Conclusion CLS with braided-suture is safe and effective as demonstrated a recovery of the QS and knee function outcome comparable to IHM. Trial registration This study was registered in Thai Clinical Trials Registry on December 2015 (https://www.clinicaltrials.in.th). The registration number was TCTR20151208003.
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Agarwal S, D'Souza R, Ryu M, Maxwell C. Barbed vs conventional suture at cesarean delivery: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2021; 100:1010-1018. [PMID: 33404082 DOI: 10.1111/aogs.14080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Barbed sutures are used in cesarean delivery with the intended benefits of better tissue approximation, hemostasis, and strength, as well as reduced operative time. A systematic review and meta-analysis was undertaken to assess the safety and efficacy of the use of barbed suture compared with conventional sutures in cesarean delivery. MATERIAL AND METHODS MEDLINE, EMBASE, PubMed, Scopus, Cochrane CENTRAL, and three clinical trial registries, were searched from inception to December 2019, without restriction by language or publication year. Randomized controlled trials comparing the use of barbed suture with conventional sutures in closure of any layer (uterine/fascial/skin) during cesarean delivery were included. The safety outcomes included estimated blood loss, pain, mortality, and other morbidity including infection, re-operation or re-admission. Effectiveness outcomes included closure time, need for additional suture and scar integrity. Study selection, data extraction, risk-of-bias, and quality assessment were independently performed by two authors. Primary analysis compared outcomes for all layers of surgical closure, whereas subgroup analysis was performed by individual layer. Pooled mean differences (MD) and risk ratios (RR) with 95% CI were calculated using a random effects model. Level of evidence was assessed using GRADE criteria. PROSPERO registration number: CRD42020168859. RESULTS The review included four trials (three comparing uterine closure and one comparing skin closure), at high risk of bias, representing 460 participants. Primary analysis showed no morbidity differences between two groups. The use of barbed suture for uterine closure was associated with shorter incision closure time (MD 110.58 seconds, 95% CI 93.79-127.36 seconds), shorter total surgical time (MD 1.92 minutes, 95% CI 0.03-3.80 minutes), and a reduced need for additional hemostatic sutures (RR 0.39, 95% CI 0.28-0.54), with no difference in estimated blood loss (MD 46.17 mL, 95% CI 13.55 to -105.89 mL) or postoperative morbidity (RR 0.96, 95% CI 0.46-2.01). The level of evidence was deemed to be low to very low, based on inconsistency and imprecision of results. CONCLUSIONS Barbed sutures may be a suitable alternative to conventional sutures for uterine closure because they reduce uterine repair time, total surgical time, and the need for additional hemostatic sutures, without an increase in blood loss or maternal morbidity.
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Affiliation(s)
- Sugandha Agarwal
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanebaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michelle Ryu
- Sidney Liswood Health Sciences Library, Mount Sinai Hospital, Toronto, Ontario, Canada.,MacDonald/Brayley Health Sciences Library, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Cynthia Maxwell
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Serrano Chinchilla P, Gamba C, León García A, Tey Pons M, Marqués López F. Use of barbed suture in total hip prosthesis. Prospective randomized study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Serrano Chinchilla P, Gamba C, León García A, Tey Pons M, Marqués López F. Use of barbed suture in total hip prosthesis. Prospective randomized study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:63-68. [PMID: 33279444 DOI: 10.1016/j.recot.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The correct closure of the surgical wound is an important step in the procedure of a total hip prosthesis implantation (total hip arthroplasty, THA), which aims to a correct healing of the wound and minimize the risk of complications. The objective of our study is to determine if the use of a bidirectional barbed suture decreases the closing time after THA, in the fascial and subcutaneous plane, when compared to the conventional suture polyglactin 910. The hypothesis is that there is no difference in closing time when comparing both sutures. MATERIAL AND METHOD Prospective single blind randomized study comparing two groups: study group with the use of bidirectional continuous barbed suture (Quill™) (Gr. Q) and a control group (Gr. V) using discontinuous polyglactin 91 suture (Vicryl™). Closure was performed in two planes (fascial and subcutaneous) simultaneously by two surgeons. The exclusion criteria were: previous surgeries on the same hip, revision surgeries, major deformities and allergies to suture components. The variables under study were: 1) fascia closure time, subcutaneous and global; 2) surgical wound infection; and 3) dehiscence. RESULTS 82 patients (39 Gr. Q, 43 Gr. V) were included. The global closing time was shorter in Gr. Q (5 min 59 sec) compared to Gr. V (7.01 min), (p < 0.04). They showed differences in subcutaneous closure: Gr. Q shorter time with a 37 seconds difference (p = 0.048). Differences in fascial plane were not observed. Superficial infection was observed in one Gr. Q patient and another in Gr. V; one case of deep infection in Gr. Q (p = 0.29). One patient presented dehiscence of the wound in Gr. Q (p = 0.3). However, these differences did not show statistical significance. CONCLUSIONS The use of a barbed suture allows a shorter closing time compared to the conventional one. However, despite this decrease in time, no differences were found in terms of the appearance of infection or wound dehiscence.
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Affiliation(s)
| | - C Gamba
- Parc de Salut Mar, Barcelona, España
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Gamba C, Hinarejos P, Serrano-Chinchilla P, Leal-Blanquet J, Torres-Claramunt R, Sánchez-Soler J, Monllau JC. Barbed Sutures in Total Knee Arthroplasty: Are They Really Useful? A Randomized Controlled Trial. J Knee Surg 2020; 33:927-930. [PMID: 31108557 DOI: 10.1055/s-0039-1688922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bidirectional barbed sutures (BBSs) have recently been investigated in total knee arthroplasty (TKA). The contrasting results from the scarce literature suggest that BBSs are safe, save time and money, and give results comparable to traditional sutures. The purpose of the study is to test the real effect of BBSs on closure time in TKA and assess the functional results as well as the complications related to them. It was a randomized controlled trial. Eighty-five patients undergoing primary TKA were assigned to receive traditional closure with Vicryl (V-group) or with BBSs (Q-group). The exclusion criteria were significant coronal deformity, flexion contracture, or the need for stem and/or augmentation. The closure time for the capsule and that for the subcutaneous layer were registered separately. Intraoperative incidences were recorded. The follow-up was up to 1 month, during which the range of motion (ROM), superficial or deep infection, and wound dehiscence were assessed. There was a significant reduction in the capsule layer (27 seconds; p = 0.02) and global time closure (51 seconds; p = 0.01) in the Q-group. No differences were found in the subcutaneous layer (24 seconds; p = 0.055). There were more intraoperative suture breakages in the Q-group, mainly in the subcutaneous layer (p < 0.001). No differences in terms of dehiscence, infection, and ROM were observed at the 1-month follow-up. BBSs allow for slightly faster wound closure than Vicryl during a TKA. However, the differences observed have minimal clinical repercussions. Moreover, no differences in the infection rate (deep or superficial), dehiscence, or ROM were found.
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Affiliation(s)
- Carlo Gamba
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Pedro Hinarejos
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Paula Serrano-Chinchilla
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Joan Leal-Blanquet
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Raul Torres-Claramunt
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Juan Sánchez-Soler
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Trauma and Orthopaedic, Hospital del Mar, Universitat Autonoma Barcelona, Barcelona, Spain
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Li P, Zhang W, Wang Y, Li J, Yan P, Guo S, Liu J, Yang K, He Z, Qian Y. Barbed suture versus traditional suture in primary total knee arthroplasty: A systematic review and meta-analysis of randomized controlled studies. Medicine (Baltimore) 2020; 99:e19945. [PMID: 32481258 PMCID: PMC7249882 DOI: 10.1097/md.0000000000019945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 02/28/2020] [Accepted: 03/14/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Barbed suture has been widely used in some surgical fields, and it has achieved good results, but the application in total knee arthroplasty is still controversial. OBJECTIVE Literature is collected for statistical analysis so as to provide evidence for the use of barbed suture in Total knee arthroplasty. METHODS We searched PubMed, the Cochrane library and EMBASE database for randomized controlled trials (RCTs) using barbed suture and conventional suture to close incisions after primary total knee arthroplasty, and the retrieval time was from July 2019 to the establishment of the database. Literature was screened according to inclusion and exclusion criteria, quality evaluation and data extraction were conducted for the final included literature, and statistical analysis was conducted using RevMan 5.3 software. RESULTS A total of six RCTs (826 knees) were included in our meta-analysis. The results showed that the re-negative conversion could shorten the wound closure time (MD -4.41, 95% CI -5.11 to -3.72, P < .00001) and reduce the wound closure total cost (MD -282.61, 95% CI -445.36 to -119.85, P = .0007) and acupuncture injury (RR 0.14, 95% CI 0.03-0.78, P = .02), and did not significantly increasing the incidence of complications (RR 0.80, 95% CI 0.05-0.96, P = .38) or suture breakages (RR 4.58, 95% CI 0.16-128.29, P = .37). There were no significant differences in ROM at postoperative 6 weeks and 3 months (MD -0.74, 95% CI -4.19 to 2.71, P = .67; MD -0.30, 95% CI -2.62 to 2.02, P = .80) and no significant differences in KSS at postoperative 6 weeks (MD -0.22, 95% CI -3.10 to 2.66, P = .88). CONCLUSIONS Our study shows that barbed suture is a fast, low-cost, safe and effective suture method in total knee arthroplasty compared with traditional suture, we also need more literature and longer follow-up to confirm this conclusion.
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Affiliation(s)
| | - Wenhui Zhang
- Gansu Provincial Hospital, Lanzhou, Gansu
- School of Clinical Medical Sciences, Ningxia Medical University
| | | | - Jinlong Li
- People's Hospital of Ningxia Hui Autonomous Region, Yinchuan
| | - Peijing Yan
- Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital
| | | | - Jie Liu
- Gansu Provincial Hospital, Lanzhou, Gansu
| | - Kehu Yang
- Institute of Clinical Research and Evidence-Based Medicine, Gansu Provincial Hospital
- Evidence-Based Social Science Research Center, Lanzhou University
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Zongru He
- Gansu Provincial Hospital, Lanzhou, Gansu
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Johnston SS, Chen BPH, Tommaselli GA, Jain S, Pracyk JB. Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison. J Wound Care 2020; 29:S9-S20. [DOI: 10.12968/jowc.2020.29.sup5a.s9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To compare economic and clinical outcomes of barbed sutures versus conventional sutures alone in wound closure for patients undergoing spinal surgery. Method: A retrospective study using the Premier Healthcare Database. The database was searched for patients who underwent elective inpatient spinal surgery (fusion or laminectomy) for a spinal disorder between 1 January 2014 and 30 June 2018 (first=index admission). Using billing records for medical supplies used during the index admission, patients were classified into mutually-exclusive groups: patients with any use of STRATAFIX (Ethicon, US) knotless tissue control devices (barbed sutures group); or patients with use of conventional sutures alone (conventional sutures group). Outcomes included the index admission's length of stay, total and subcategories of hospital costs, non-home discharge, operating room time (ORT, minutes), wound complications and readmissions within ≤90 days. Propensity score matching and generalised estimating equations were used to compare outcomes between the study groups. Results: After matching, 3705 patients were allocated to each group (mean age=61.5 years [standard deviation, SD±12.9]; 54% were females). Compared with the conventional suture group, the barbed suture group had significantly lower mean ORT (239±117 minutes, versus 263±79 minutes conventional sutures, p=0.015). Operating room costs were also siginificantly lower in the barbed suture group ($6673±$3976 versus $7100±$2700 conventional sutures, p=0.020). Differences were statistically insignificant for other outcomes (all p>0.05). Subanalysis of patients undergoing fusions of ≥2 vertebral joints yielded consistent results. Conclusion: In this study, wound closure incorporating barbed sutures was associated with lower ORT and operating room costs, with no significant difference in wound complications or readmissions, when compared with conventional sutures alone.
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Affiliation(s)
- Stephen S Johnston
- PhD, Director; Medical Devices, Epidemiology, Johnson & Johnson, New Brunswick, NJ, US
| | - Brian Po-Han Chen
- MS, Associate Director; Health Economics and Market Access, Ethicon, Johnson & Johnson, Somerville, NJ, US
| | - Giovanni A Tommaselli
- MD, PhD, Medical Director; Pre-Clinical & Clinical Research, Medical Affairs, Ethicon, Johnson & Johnson, Somerville, NJ, US
| | - Simran Jain
- BS, Apprentice Leader; Mu Sigma, Bangalore, India
| | - John B Pracyk
- MD, PhD, MBA, Integrated Leader; Pre-Clinical & Clinical Research, Medical Affairs, DePuy Synthes Spine, Johnson & Johnson, Raynham, MA, US
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Goto S, Sakamoto T, Ganeko R, Hida K, Furukawa TA, Sakai Y. Subcuticular sutures for skin closure in non-obstetric surgery. Cochrane Database Syst Rev 2020; 4:CD012124. [PMID: 32271475 PMCID: PMC7144739 DOI: 10.1002/14651858.cd012124.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Following surgery, surgical wounds can be closed using a variety of devices including sutures (subcuticular or transdermal), staples and tissue adhesives. Subcuticular sutures are intradermal stitches (placed immediately below the epidermal layer). The increased availability of synthetic absorbable filaments (stitches which are absorbed by the body and do not have to be removed) has led to an increased use of subcuticular sutures. However, in non-obstetric surgery, there is still controversy about whether subcuticular sutures increase the incidence of wound complications. OBJECTIVES To examine the efficacy and acceptability of subcuticular sutures for skin closure in non-obstetric surgery. SEARCH METHODS In March 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA All randomised controlled trials which compared subcuticular sutures with any other methods for skin closure in non-obstetric surgery were included in the review. DATA COLLECTION AND ANALYSIS Two review authors independently identified the trials, extracted data and carried out risk of bias and GRADE assessment of the certainty of the evidence. MAIN RESULTS We included 66 studies (7487 participants); 11 included trials had more than two arms. Most trials had poorly-reported methodology, meaning that it is unclear whether they were at high risk of bias. Most trials compared subcuticular sutures with transdermal sutures, skin staples or tissue adhesives. Most outcomes prespecified in the review protocol were reported. The certainty of evidence varied from high to very low in the comparisons of subcuticular sutures with transdermal sutures or staples and tissue adhesives; the certainty of the evidence for the comparison with surgical tapes and zippers was low to very low. Most evidence was downgraded for imprecision or risk of bias. Although the majority of studies enrolled people who underwent CDC class 1 (clean) surgeries, two-thirds of participants were enrolled in studies which included CDC class 2 to 4 surgeries, such as appendectomies and gastrointestinal surgeries. Most participants were adults in a hospital setting. Subcuticular sutures versus transdermal sutures There may be little difference in the incidence of SSI (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.80 to 1.52; 3107 participants; low-certainty evidence). It is uncertain whether subcuticular sutures reduce wound complications (RR 0.83; 95% CI 0.40 to 1.71; 1489 participants; very low-certainty evidence). Subcuticular sutures probably improve patient satisfaction (score from 1 to 10) (at 30 days; MD 1.60, 95% CI 1.32 to 1.88; 290 participants; moderate-certainty evidence). Wound closure time is probably longer when subcuticular sutures are used (MD 5.81 minutes; 95% CI 5.13 to 6.49 minutes; 585 participants; moderate-certainty evidence). Subcuticular sutures versus skin staples There is moderate-certainty evidence that, when compared with skin staples, subcuticular sutures probably have little effect on SSI (RR 0.81, 95% CI 0.64 to 1.01; 4163 participants); but probably decrease the incidence of wound complications (RR 0.79, 95% CI 0.64 to 0.98; 2973 participants). Subcuticular sutures are associated with slightly higher patient satisfaction (score from 1 to 5) (MD 0.20, 95% CI 0.10 to 0.30; 1232 participants; high-certainty evidence). Wound closure time may also be longer compared with staples (MD 0.30 to 5.50 minutes; 1384 participants; low-certainty evidence). Subcuticular sutures versus tissue adhesives, surgical tapes and zippers There is moderate-certainty evidence showing no clear difference in the incidence of SSI between participants treated with subcuticular sutures and those treated with tissue adhesives (RR 0.77, 95% CI 0.41 to 1.45; 869 participants). There is also no clear difference in the incidence of wound complications (RR 0.62, 95% CI 0.35 to 1.11; 1058 participants; low-certainty evidence). Subcuticular sutures may also achieve lower patient satisfaction ratings (score from 1 to 10) (MD -2.05, 95% CI -3.05 to -1.05; 131 participants) (low-certainty evidence). In terms of SSI incidence, the evidence is uncertain when subcuticular sutures are compared with surgical tapes (RR 1.31, 95% CI 0.40 to 4.27; 354 participants; very low-certainty evidence) or surgical zippers (RR 0.80, 95% CI 0.08 to 8.48; 424 participants; very low-certainty evidence). There may be little difference in the incidence of wound complications between participants treated with subcuticular sutures and those treated with surgical tapes (RR 0.90, 95% CI 0.61 to 1.34; 492 participants; low-certainty evidence). It is uncertain whether subcuticular sutures reduce the risk of wound complications compared with surgical zippers (RR 0.55, 95% CI 0.15 to 2.04; 424 participants; very low-certainty evidence). It is also uncertain whether it takes longer to close a wound with subcuticular sutures compared with tissue adhesives (MD -0.34 to 10.39 minutes; 895 participants), surgical tapes (MD 0.74 to 6.36 minutes; 169 participants) or zippers (MD 4.38 to 8.25 minutes; 424 participants) (very low-certainty evidence). No study reported results for patient satisfaction compared with surgical tapes or zippers. AUTHORS' CONCLUSIONS There is no clear difference in the incidence of SSI for subcuticular sutures in comparison with any other skin closure methods. Subcuticular sutures probably reduce wound complications compared with staples, and probably improve patient satisfaction compared with transdermal sutures or staples. However, tissue adhesives may improve patient satisfaction compared with subcuticular sutures, and transdermal sutures and skin staples may be quicker to apply than subcuticular sutures. The quality of the evidence ranged from high to very low; evidence for almost all comparisons was subject to some limitations. There seems to be no need for additional new trials to explore the comparison with staples because there are high-quality studies with large sample sizes and some ongoing studies. However, there is a need for studies exploring the comparisons with transdermal sutures, tissue adhesives, tapes and zippers, with high-quality studies and large sample sizes, including long-term assessments.
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Affiliation(s)
- Saori Goto
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Takashi Sakamoto
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Riki Ganeko
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Koya Hida
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
| | - Yoshiharu Sakai
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
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Michalowitz A, Comrie R, Nicholas C, Wagner M, Kehoe J. Wound Complications after 2-Octyl Skin Closure Systems for Total Joint Arthroplasty. J Bone Jt Infect 2020; 5:101-105. [PMID: 32455101 PMCID: PMC7242402 DOI: 10.7150/jbji.42079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 01/05/2023] Open
Abstract
Introduction: Total joint arthroplasty is projected to expand rapidly by 2030. With large numbers of patients undergoing TJA, the choice of incisional closure has come into question. We compared the 2-Ocyl cyanoacrylate closure system of Dermabond ® Prineo ® with Exofin Fusion ® to compare rates of adverse wound outcomes after total joint arthroplasty. Secondary outcome measures were age, sex, and medical comorbidities between groups. Methods: We retrospectively reviewed adverse wound outcomes with skin closure in TJA in 281 patients (160 Dermabond Prineo and 121 Exofin Fusion). Clinical charts were analyzed out to the 6-week post-op visit. Results: The rate of overall adverse superficial wound outcomes was similar between the two groups with Dermabond Prineo (N=20) and Exofin Fusion (N=19). The rate of cellulitis was significantly higher for Dermabond Prineo when compared to Exofin Fusion (P=0.033). No other significant differences were found for rate of superficial or deep wound complications or for secondary outcomes. Conclusions: The two 2-octyl wound closure systems had similar adverse superficial wound complications. Except for Dermabond Prineo having a higher rate of post-operative cellulitis, there were no statistically significant differences for other superficial or deep adverse wound outcomes or secondary outcomes. A future randomized control trial or prospective cohort study is needed for a more robust analysis.
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Li E, Niu W, Lu T, Li X, Zhang T, Cai J, Wang W. A comparison between barbed suture and conventional suture in total knee arthroplasty: a systematic review and meta-analysis. ARTHROPLASTY 2020; 2:8. [PMID: 35236431 PMCID: PMC8796359 DOI: 10.1186/s42836-020-00028-6] [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: 01/04/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the efficacy of barbed versus conventional sutures in total knee arthroplasty. METHODS Two investigators independently performed data extraction and assessed study quality using the keywords "barbed suture, wound suture, total knee arthroplasty" in two search trials, individual trials, and trials from Systematic Reviews or Meta-analyses in PubMed, Cochrane Library, Web of Science, and EMBASE databases. RESULT A total of 11 articles (involving 1546 total knee arthroplasties) were included in this study. Comparison was made between barbed and conventional sutures in terms of various measures. No significant differences were identified in superficial infection and deep infection (p > 0.51; odds ratio 0.84 [95% confidence interval, 0.50, 1.4] and p > 0.28; odds ratio 0.50 [95% confidence interval, 0.14, 1.75], respectively). There was no significant difference in time for capsular suture (p < 0.05; odds ratio - 4.05 [95% confidence interval, - 4.39, - 3.71]). There existed no significant differences in Hospital for Special Surgery Knee Score and Knee Society Score (p > 0.05; odds ratio - 1.20 [95% confidence interval, - 2.98, 0.58] and p > 0.05; odds ratio - 1.62 [95% confidence interval, - 4.06, 0.18], respectively). No significant differences were revealed in suture breakage and needle stick injury (p < 0.05; odds ratio 36.51 [95% confidence interval, 7.06, 188.72] and p < 0.05; odds ratio 0.16 [95% confidence interval, 0.04, 0.72], respectively). No significant difference was exhibited in dehiscence (p = 0.99; odds ratio 0.99 [95% confidence interval, 0.41, 2.38]). CONCLUSION In total knee arthroplasty, both barbed and conventional sutures yielded similar results in terms of superficial and deep infection, Hospital for Special Surgery Knee Score, Knee Society Score, and wound dehiscence. Barbed suture was associated with higher incidence of suture breakage, shorter suture time, and less needle stick injury.
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Affiliation(s)
- Erliang Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
- Department of Orthopedics, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Wenjing Niu
- The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, 710000, China
| | - Tingting Lu
- GRADE Working Group China Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Xiaolin Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China
- Department of Orthopedics, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Tong Zhang
- Department of Orthopedics, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Jinchi Cai
- Department of Orthopedics, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Wenji Wang
- Department of Orthopedics, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
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Sundaram K, Warren JA, Klika A, Piuzzi NS, Mont MA, Krebs V. Barbed sutures reduce arthrotomy closure duration compared to interrupted conventional sutures for total knee arthroplasty: a randomized controlled trial. Musculoskelet Surg 2020; 105:275-281. [PMID: 32146687 DOI: 10.1007/s12306-020-00654-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/25/2020] [Indexed: 11/30/2022]
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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Affiliation(s)
- K Sundaram
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - J A Warren
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - A Klika
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - N S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - M A Mont
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, 10075, USA
| | - V Krebs
- Department of Orthopedic Surgery, Cleveland Clinic, A41, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Infected Spinal Wounds Should be Closed With Nonbarbed Monofilament Suture. Clin Spine Surg 2020; 33:50-52. [PMID: 30681415 DOI: 10.1097/bsd.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Buttrick SS, Eichberg D, Ali SC, Komotar RJ. Intradermal Scalp Closure Using Barbed Suture in Cranial Tumor Surgeries: A Technical Note. Oper Neurosurg (Hagerstown) 2019; 15:E5-E8. [PMID: 28962024 DOI: 10.1093/ons/opx195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Traditional scalp closure technique following elective craniotomy involves placement of staples or a continuous running suture. Despite low complication rates, these techniques are often considered to be disfiguring by patients, contribute to the psychosocial trauma of brain surgery, and are associated with discomfort during postoperative staple or suture removal. Some authors have described scalp closure using intradermal absorbable suture, but this technique likely does not reach the tensile strength of closure using traditional methods, and requires knots at the apices of the incision, which can act as a nidus for infection. CLINICAL PRESENTATION We employed a barbed intradermal closure method in supratentorial elective craniotomies for tumor resection. Complication rates were recorded, and cosmetic outcomes were informally assessed. Intradermal closure with barbed sutures was utilized in 76 patients. At the 2-wk postoperative clinic visit, cosmetic outcomes were excellent in all cases. There was 1 superficial wound infection that presented 6 wk after a pterional craniotomy for low-grade glioma. This resolved with superficial wound revision and oral antibiotic therapy. CONCLUSION We present a novel scalp closure technique for craniotomies using intradermal barbed Monocryl suture. We have had excellent cosmetic outcomes, and the infection rate of 1.3% compares favorably to published rates. Further studies are required to quantify the improvement in patient satisfaction compared to conventional closure methods.
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Affiliation(s)
- Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sheikh C Ali
- College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Thacher RR, Herndon CL, Jennings EL, Sarpong NO, Geller JA. The Impact of Running, Monofilament Barbed Suture for Subcutaneous Tissue Closure on Infection Rates in Total Hip Arthroplasty: A Retrospective Cohort Analysis. J Arthroplasty 2019; 34:2006-2010. [PMID: 31182411 DOI: 10.1016/j.arth.2019.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recently, running, monofilament barbed suture has become more popular as an efficient and economical alternative to traditional braided interrupted suture for wound closure following total joint arthroplasty. Its overall association with wound complications following surgery remains unknown at this time. Several studies have investigated its use in total knee arthroplasty (TKA), but there is limited literature surrounding use in total hip arthroplasty (THA). In this retrospective cohort study, our primary objective was to determine whether the use of monofilament barbed suture in THA was associated with reduced rates of postoperative infection when compared to traditional braided suture. METHODS Patients who underwent primary unilateral THA between November 2011 and December 2017 by a single senior surgeon with closure using either monofilament barbed suture (162 patients) or braided interrupted suture (429 patients) were retrospectively reviewed for postoperative wound complications during the first 90 days after surgery. Demographics, comorbidities, and perioperative data were also included to assess for risk factors for infection. RESULTS There was no difference between braided and barbed suture in overall rates of major complication, including periprosthetic joint infection (PJI) (0.47% vs 0.62%, P = .82) or revisions (1.86% vs 1.23%, P = .60). The overall rate of minor, superficial wound complications was also similar between both groups (6.1% vs 3.1%, P = .15). However, when superficial complications were categorized by type (dehiscence vs infection), the use of barbed suture was associated with a decreased rate of superficial wound infection (0% vs 5.4%, P = .003) and an increased rate of wound dehiscence (3.1% vs 0.7%, P = .04). CONCLUSION The use of monofilament barbed suture for superficial skin closure in THA leads to similar overall rates of both major and minor wound complications when compared to traditional interrupted braided suture. However, while barbed suture was associated with fewer superficial infections, there was an increased incidence of wound dehiscence. Overall, barbed suture demonstrated a cumulatively equivalent rate of superficial wound complications compared to braided suture. Based on this investigation, barbed suture appears safe to use in THA and may represent an efficient and effective alternative to braided suture for wound closure. LEVEL OF EVIDENCE Level IV; retrospective cohort study.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, New York, NY
| | - Carl L Herndon
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, New York, NY
| | - Emma L Jennings
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, New York, NY
| | - Nana O Sarpong
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, New York, NY
| | - Jeffrey A Geller
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Irving Medical Center, New York, NY
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Xin WQ, Zhao Y, Wang H, Wu J, Wang HY, Gao YK, Yang XY. A better strategy using barbed sutures for wound closure in total knee arthroplasty. J Comp Eff Res 2019; 8:799-814. [PMID: 31359779 DOI: 10.2217/cer-2019-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The purpose of this study was to conduct a meta-analysis to systematically compare the clinical outcomes between knee barbed sutures (KBS) and knee traditional sutures (KTS) for wound closure in total knee arthroplasty (TKA). Method: This study retrieved potential academic articles comparing the clinical outcomes between KBS and KTS in TKA from the MEDLINE database, the PubMed database, the EMBASE database and the Cochrane Library. The reference articles for the identified studies were carefully reviewed to ensure that all available documents were represented in the study. Results: A total of 14 articles (eight randomized controlled trials [RCTs], six non-RCTs) were involved in our study. The overall participants of barbed Sutures group were 1255, whereas it was 1247 in the traditional sutures. Our meta-analysis showed that KBS is preferable for wound closure of TKA as its shorter lower total cost (weighted mean difference [WMD] = -276.281, 95% CI = -480.281 to -72.280; p = 0.008) and wound closure time (WMD = -4.895,95% CI = -6.105 to -3.685; p < 0.001). However, there was no difference in any complications (p = 0.572), wound complications (p = 0.550), superficial infection (p = 0.918), deep infection (p = 0.654), wound dehiscence (p = 0.649), suture abscess (p = 0.939), arthrofibrosis (p = 0.970), needle sticks (p = 0.158), suture breakage (p = 0.371) and knee society scores (KSS; p = 0.073). Conclusion: The use of KBS in TKA is associated with significantly shortened wound closure times and total closure cost without increased risk of intraoperative needle sticks and suture breakage and postoperative incision complications. Given the relevant possible biases in our study, adequately powered and more RCTs with long-term follow-up are needed to compare the efficacy and safety between KBS and KTS.
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Affiliation(s)
- Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 30052, PR China
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 30052, PR China
| | - Hao Wang
- Department of Orthopedics, Characteristic Medical Center of Chinese Armed Police Force, Tianjin 300162, PR China
| | - Jun Wu
- Department of Neurosurgery, Fuzhou First People's Hospital, Fuzhou, Jiangxi 344000, PR China
| | - Hong-Yu Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 30052, PR China
| | - Yi-Kuan Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 30052, PR China
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 30052, PR China
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Al-Houraibi RK, Aalirezaie A, Adib F, Anoushiravani A, Bhashyam A, Binlaksar R, Blevins K, Bonanzinga T, Chih-Kuo F, Cordova M, Deirmengian GK, Fillingham Y, Frenkel T, Gomez J, Gundtoft P, Harris MA, Harris M, Heller S, Jennings JA, Jiménez-Garrido C, Karam JA, Khlopas A, Klement MR, Komnos G, Krebs V, Lachiewicz P, Miller AO, Mont MA, Montañez E, Romero CA, Schwarzkopf R, Shaffer A, Sharkey PF, Smith BM, Sodhi N, Thienpont E, Villanueva AO, Yazdi H. General Assembly, Prevention, Wound Management: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S157-S168. [PMID: 30360978 DOI: 10.1016/j.arth.2018.09.066] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Kobayashi S, Niki Y, Harato K, Udagawa K, Matsumoto M, Nakamura M. The effects of barbed suture on watertightness after knee arthrotomy closure: a cadaveric study. J Orthop Surg Res 2018; 13:323. [PMID: 30572958 PMCID: PMC6302503 DOI: 10.1186/s13018-018-1035-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Wound closure is one of the crucial aspects of total knee arthroplasty (TKA) for patients who perform high-flexion activities of daily living, because the joint capsule is highly stretched and integrity of the arthrotomy closure must be maintained. Watertightness of the knee joint is a different aspect of the repair integrity of arthrotomy closure and is being noticed with increasing usage of the drain clamp method for blood management after TKA. Recently, the barbed knotless suture has been growing in popularity as a strong, secure closure appropriate for high-tension areas, such as the fascia and joint capsule. The purpose of this study was to compare the barbed knotless suture with simple interrupted suture in cadaveric knees. Methods Nine fresh-frozen cadaveric lower extremities were used. After placing a parapatellar incision and setting a closed suction drain, arthrotomies were closed randomly using three suture materials: simple interrupted absorbable suture (No. 0 PDS, group C); or a single running knotless barbed suture Stratafix with 8N (group BS-8N) or 15N (group BS-15N) of tension. After arthrotomy closure, saline was injected in a retrograde manner into the joint through a drain until saline started to leak from the joint. Peak values for intra-articular pressure and infusion volume in each group were recorded and compared. Results Mean infusion volumes were 13.0 ± 7.2 ml, 38.6 ± 10.7 ml, and 5.1 ± 2.5 ml in groups BS-8N, BS-15N, and C, respectively. Mean intra-articular pressures were 0.67 ± 0.47 kPa, 9.44 ± 4.55 kPa, and 0.56 ± 0.44 kPa in groups BS-8N, BS-15N, and C, respectively. Infusion volume and joint internal pressure were significantly higher in group BS-15N than in groups BS-8N (p = 0.008) or C (p = 0.04). Conclusions Barbed suture with 15N appears appropriate for maintaining maximal watertightness after knee joint capsule closure, offering successful drain clamping, higher resistance to early mobilization protocols, and subsequent achievement of early deep knee flexion after TKA. Electronic supplementary material The online version of this article (10.1186/s13018-018-1035-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu Kobayashi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kengo Harato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kazuhiko Udagawa
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Sutton N, Schmitz ND, Johnston SS. Comparing outcomes between barbed and conventional sutures in patients undergoing knee or hip arthroplasty. J Comp Eff Res 2018; 7:975-987. [PMID: 30070596 DOI: 10.2217/cer-2018-0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM To compare outcomes between barbed sutures and conventional sutures among patients undergoing knee or hip arthroplasty. MATERIALS & METHODS Retrospective study of patients (aged ≥18 years) undergoing elective knee/hip arthroplasty for osteoarthritis between 1 January 2013 and 1 September 2015. Patients were classified as: any Stratafix™ Knotless Tissue Control Devices (barbed suture group) used for closure vs. conventional sutures only (conventional suture group). RESULTS Compared with the conventional suture group, the barbed suture group had statistically significant: shorter length of stay, knee = 0.2 d; hip = 0.3 d and operating room time, knee = 7 min; hip = 22 min and lower rate of discharge to skilled nursing facility/nonhome setting (knee = 3.0%; hip = 6.8%). CONCLUSION Use of barbed sutures was associated with shorter length of stay, operating room time and less resource intensive discharge status as compared with conventional sutures alone.
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Affiliation(s)
- Nadia Sutton
- Johnson & Johnson Services Inc., 501 George Street, #JH2226, New Brunswick, NJ 08901, USA
| | - Niels-Derrek Schmitz
- Ethicon, Johnson & Johnson, Research & Development Medical Affairs, Norderstedt, Germany
| | - Stephen S Johnston
- Real World Data Analytics & Research, Johnson & Johnson, Epidemiology, Medical Devices, 410 George Street, New Brunswick, NJ 08901, USA
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Han Y, Yang W, Pan J, Zeng L, Liang G, Lin J, Luo M, Guo D, Liu J. The efficacy and safety of knotless barbed sutures in total joint arthroplasty: a meta-analysis of randomized-controlled trials. Arch Orthop Trauma Surg 2018; 138:1335-1345. [PMID: 29909494 PMCID: PMC6132945 DOI: 10.1007/s00402-018-2979-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The knotless barbed sutures (KBS) are an innovative type of suture that can accelerate the placement of sutures and eliminate knot tying. Whether the KBS are safe and efficient in total joint arthroplasty (TJA) remains controversial. Therefore, we conducted a meta-analysis to evaluate its efficacy and safety. METHODS Randomized-controlled trials (RCTs) were identified from the PubMed, Embase, and Cochrane Library databases up to October 2017. The Cochrane risk of bias tool was used to assess methodological quality. The statistical analysis was performed with RevMan 5.3.5 software. RESULTS A total of five RCTs (600 participants) were included in our meta-analysis. The results showed that KBS reduced wound suture time (MD - 4.51, 95% CI - 5.37 to - 3.66, P < 0.00001) and the wound suture cost (MD - 282.63, 95% CI - 445.32 to - 119.95, P < 0.00001), and did not significantly increase the rate of complications (OR 0.77, 95% CI 0.42-1.39, P = 0.13) or intraoperative events (OR 0.86, 95% CI 0.04-17.28, P = 0.92). There were no significant differences in ROM at postoperative 6 weeks and 3 months (MD - 0.74, 95% CI - 4.19 to 2.71, P = 0.67; MD - 0.30, 95% CI - 2.62 to 2.02, P = 0.80; respectively). CONCLUSION Our findings suggest that KBS are a safe and effective method for TJA. Given the possible biases, adequately powered and better designed studies with longer follow-up are required to reach a firmer conclusion.
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Affiliation(s)
- Yanhong Han
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405 China ,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Weiyi Yang
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China
| | - Jianke Pan
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China ,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Lingfeng Zeng
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China ,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Guihong Liang
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China ,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Jiongtong Lin
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510405 China ,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
| | - Minghui Luo
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China
| | - Da Guo
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China
| | - Jun Liu
- Department of Orthopedics, Second Affiliated Hospital, Guangzhou University of Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120 Guangdong China ,Bone and Joint Research Team of Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, 510120 China
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Elmallah RK, Khlopas A, Faour M, Chughtai M, Malkani AL, Bonutti PM, Roche M, Harwin SF, Mont MA. Economic evaluation of different suture closure methods: barbed versus traditional interrupted sutures. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:S26. [PMID: 29299473 DOI: 10.21037/atm.2017.08.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Healthcare systems are receiving increasing pressures from payers, such as the Centers for Medicare and Medicaid (CMS), to reduce the costs associated with procedures, and with the implementation of the Affordable Care Act, high costs are addressed through pay-for-performance programs. Thus, multiple areas of total knee arthroplasty (TKA) surgery are under scrutiny, including surgical times, material costs, and the costs of associated complications and readmissions. Suture type has been determined to be a factor that may influence closure times, as well as direct material costs. Therefore, the purpose of this review was to compare: (I) the cost of using barbed vs. conventional interrupted sutures; (II) the additional cost of differences in complications, if any; (III) to extrapolate cost savings on a hospital and national level; and (IV) to discuss the role of these findings on hospital savings and the effect on bundled payments. It was found that the main factors affecting differences in overall costs between barbed and standard interrupted suture were material cost and closure time. Many studies have demonstrated greater cost savings with the barbed suture due to shorter operative times, despite the higher material costs. The majority of studies also demonstrated similar complication rates between the suture types, and thus these are unlikely to affect the cost difference. However, to the best of our knowledge, there are no TKA studies in the literature evaluating the effect of suture type and associated complications on lengths of stay and readmission rates. Thus, it is unclear how these cost savings will translate to reimbursements rates and the role that they might play in bundled payments. Several studies in other specialties demonstrate decreased infection rates with the use of barbed sutures, which, if found to be true for TKA can be extrapolated to 3 million dollars of savings in revision TKA costs. Further studies on this topic are needed to define these relationships.
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Affiliation(s)
- Randa K Elmallah
- Department of Orthopaedic Surgery, University of Mississippi, Jackson, Mississippi, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mhamad Faour
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Arthur L Malkani
- Adult Reconstruction Program, University of Louisville, Louisville, Kentucky, USA
| | | | - Martin Roche
- Department of Orthopaedic Surgery, Holy Cross Orthopaedic Institute, Fort Lauderdale, Florida, USA
| | - Steven F Harwin
- Department of Orthopaedic Surgery, Mount Sinai West, New York, New York, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Carli AV, Spiro S, Barlow BT, Haas SB. Using a non-invasive secure skin closure following total knee arthroplasty leads to fewer wound complications and no patient home care visits compared to surgical staples. Knee 2017; 24:1221-1226. [PMID: 28797879 DOI: 10.1016/j.knee.2017.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/18/2017] [Accepted: 07/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Superficial wound complications occur in up to 10% of total knee arthroplasty (TKA) procedures and have been associated with periprosthetic joint infection. The ideal material for TKA closure should offer: 1) fast intraoperative application, 2) minimal wound complications and 3) removable by patients without assistance. We evaluated a novel, non-invasive, removable skin closure system for TKA to determine its effect on wound complications. METHODS We prospectively evaluated 221 consecutive TKA patients who received skin closure using a non-invasive zipper-like system ('Zip'; Zip 16 Surgical Skin Closure System; Zipline Medical). All procedures were performed by a single surgeon using the mini-midvastus approach. Patients received two weeks of rivaroxaban postoperatively. Demographics, comorbidities, in-hospital complications and six-week wound evaluation were recorded. Data was compared to a cohort of 1001 patients from the same surgeon who received staples for closure and coumadin for thromboprophylaxis. RESULTS Zip patients had a significantly higher BMI (p=0.001), incidence of diabetes (p=0.035) and smoking (p=0.005). Zip patients removed dressings themselves and did not report problems with dressing care. Rate of readmission for wound-related complications was significantly lower in the Zip closure group (p=0.045). Overall readmission rates were similar between groups. CONCLUSIONS In our experience, the Zip 16 Surgical Skin Closure System is easy to apply, avoids home care and has produced fewer wound complications compared to staples. Results have been positive despite the study cohort having a higher number of diabetic patients and using an anticoagulant associated with a higher risk of wound complications.
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Affiliation(s)
| | - Sara Spiro
- Hospital for Special Surgery, New York, USA
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