The use of a barbed suture in hip and knee replacement wound closure

Barbed suture versus traditional suture in primary total knee arthroplasty: A systematic review and meta-analysis of randomized controlled studies

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.

3D Printed Anchoring Sutures for Permanent Shaping of Tissues

Sutures are one of the most widely used devices for adhering separated tissues after injury or surgery. However, most sutures require knotting, which can create a risk of inflammation, and can act as mechanically weak points that often result in breakage and slipping. Here, an anchoring suture is presented with a design that facilitates its propagation parallel to the suturing direction, while maximizing its resistive force against the opposite direction of external force to lock its position in tissues. Different microstructures of suture anchors are systematically designed using orthogonal arrays, and selected based on shape factors associated with mechanical strength. 3D printing is used to fabricate different types of hollow microstructured suture anchors, and optimize their structure for the effective shaping of tissues. To define the structural design for fixing tissues, the maximum force required to pull 3D printed anchors in different directions is examined with tissues. The tissue reshaping function of suture anchors is further simulated ex vivo by using swine ear, nose, and skin, and bovine muscle tendon. This study provides advantages for building functional sutures that can be used for permanently reshaping tissues with enhanced mechanical strength, eliminating the need for knotting to improve surgical efficiency.

Barbed Suture Is Associated With Increased Risk of Wound Infection After Unicompartmental Knee Arthroplasty

BACKGROUND

Literature addressing the risks of barbed suture in arthroplasty remains limited. No study to our knowledge has compared rates of wound infection between barbed and conventional suture after unicompartmental knee arthroplasty (UKA). We hypothesized that barbed suture would be associated with an increased risk of wound infection in patients undergoing UKA.

METHODS

Electronic records were retrieved for 1040 UKA procedures. Odds ratios with postoperative wound infection as the outcome and barbed suture as the exposure were calculated. Binary logistic regression corrected for age, gender, body mass index, operative time, and risk factors (smoking, diabetes, renal insufficiency, and immunosuppression). Barbed suture consisted of Quill #2 polydioxanone (or #0 Vicryl) for deep closure and Quill 2-0 Monoderm for subcuticular closure. Conventional suture consisted of #0 Vicryl for deep closure and subcuticular 2-0 Monocryl or staples for skin closure.

RESULTS

A total of 839 procedures were included. Barbed suture was used in 333 surgeries, and conventional suture was used in 506. Eight cases of postoperative wound infection were identified. All infections occurred in the barbed suture cohort. Regression analysis revealed an association between subcuticular barbed suture and postoperative wound infection (odds ratio = 22.818, confidence interval = 2.69-2923.91; P = .0074).

CONCLUSIONS

The findings indicate that the use of barbed suture in subcuticular layer closure is associated with an increased risk of wound infection. This may be exacerbated by early intensive mobilization, commonly undertaken after UKA to permit rapid functional return. We recommend against the use of barbed suture for subcuticular layer closure in UKA.

Barbed versus traditional sutures for wound closure in knee arthroplasty: a systematic review and meta-analysis

Sutures are an increasing focus of research in knee arthroplasty (KA). Whether knotless barbed sutures (KBS) are safe and efficient in KA remains controversial. The objective of our study is to compare the clinical outcomes of KA according to wound closure method: KBS versus knotted traditional sutures (KTS). To clarify this, we conducted a systematic review and meta-analysis. Nine articles involving 10 studies were included in this study. The dataset consisted of 1729 patients with 1754 KA. Among these, 814 patients’ wounds were closed with KBS and 915 with KTS. Our analysis indicates that KBS is preferable for KA wound closure given its shorter wound closure time and lower total cost; postoperative Knee Society scores and complication rates were similar to those of surgeries using KTS. The subgroup analysis revealed that closure of arthrotomy with KBS appears to be associated with a lower risk of complications. This meta-analysis indicates that use of KBS in KA reduces operative time and cost. KBS is the preferred option for wound closures, including arthrotomy and reattachment of subcutaneous and subcuticular tissues. Given the possible biases, adequately powered and better-designed studies with longer follow-up are required to reach a firmer conclusion.