Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomised controlled trial

Abstract

INTRODUCTION: Recently introduced barbed suture allows continuous knotless suturing, provides faster closure, and distributes tension evenly. Research on barbed sutures in total knee arthroplasty (TKA) is limited and yield conflicting results. The primary objective of this study was to compare barbed and traditional sutures in terms of wound closure time and cost. The secondary objective was to compare differences in wound complications, cosmesis, and clinical outcomes. MATERIALS AND METHODS: This was a randomised controlled study approved by Institutional Review Board. Patients with osteoarthritis requiring primary TKA were randomised into 2 groups. For traditional group, interrupted and continuous suturing of Vicryl was used for arthrotomy and subcutaneous closure, respectively. For barbed group, continuous knotless suturing of Stratafix was used for arthrotomy and subcutaneous closure. Wound closure time, leak test, and any other intra-operative events were recorded. Wound complications, cosmesis rating, Knee Society Score (KSS), and range of motion (ROM) were measured at 2 weeks, 6 weeks, and 3 months. RESULTS: A total of 24 TKAs in barbed group and 23 in traditional group were included. Both arthrotomy and subcutaneous closure time were significantly shorter in barbed than traditional group (arthrotomy 309.8 vs. 467.4 seconds [p<0.01]; subcutaneous 277.3 vs. 398.7 seconds [p<0.01]). Four positive leak test in traditional group, while none in barbed group were noted (p<0.05). No significant difference was noted in wound complication, cosmesis, ROM, and KSS. DISCUSSION AND CONCLUSION: Our study demonstrated that bidirectional barbed suture shortens arthrotomy and subcutaneous closure time, reduces cost, and improves efficiency of TKA. We also showed that barbed suture provides a more robust arthrotomy closure, with comparable wound complications and clinical outcomes.