Abstract
ObjectiveThe aim of this systematic review and meta-analysis was to evaluate the efficacy of barbed versus conventional sutures in total knee arthroplasty.MethodsTwo 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.ResultA 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]).ConclusionIn 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.
Highlights
A total knee arthroplasty (TKA) involves replacement of all three compartments of the diseased knee joint [1]
11 studies were included according to the inclusion and exclusion criteria (Fig. 1)
Risks of bias assessment of eight Randomized controlled trial (RCT) studies are shown in Figs. 2 and 3
Summary
A total knee arthroplasty (TKA) involves replacement of all three compartments of the diseased knee joint [1]. Wound closure involves the use of sutures in an interrupted, layered closure, with or without the use of skin staples [4]. Simple interrupted suture is regarded as most appropriate for wounds with wellapproximated skin edges under no tension [5]. In a retrospective study of 181 patients, Newman et al [8] found that use of staple was associated with fewer complications than use of suture. More studies concluded that nylon sutures and skin staples had similar wound complication rates, patient satisfaction with wound appearance, and cosmesis scores [9]. Optimal suture method for TKA remains a matter of debate with contradictory results
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