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Barbed versus standard sutures in total knee arthroplasty: a meta-analysis

  • Sanjay Meena
  • Shreesh Gangary
  • Pankaj Sharma
  • Buddhadev Chowdhury
General Review • LOWER LIMB - ARHROPLASTY

Abstract

Introduction

The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty.

Methods

We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs.

Results

Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36–2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI −2.74, CI −3.06, −2.42, P < 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time.

Conclusion

Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures.

Keywords

Barbed suture Knee arthroplasty Infection Quill 

Notes

Conflict of interest

None.

References

  1. 1.
    Trott AT (2005) Wound and lacerations: emergency care and closure, 3rd edn. Mosby, PhiladelphiaGoogle Scholar
  2. 2.
    Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Joint Surg Am 17 96(18):e158CrossRefGoogle Scholar
  3. 3.
    Khan RJ et al (2006) A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br 88(2):238PubMedCrossRefGoogle Scholar
  4. 4.
    Smith TO, Sexton D, Mann C, Donell S (2010) Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ 16(340):c1199CrossRefGoogle Scholar
  5. 5.
    Eickmann T, Quane E (2010) Total knee arthroplasty closure with barbed sutures. J Knee Surg 23(3):163–167PubMedCrossRefGoogle Scholar
  6. 6.
    Vakil JJ, O’Reilly MP, Sutter EG et al (2011) Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplast 26(5):710–713CrossRefGoogle Scholar
  7. 7.
    Rosen AD (2013) New and emerging uses of barbed suture technology in plastic surgery. Aesthet Surg 33(3 Suppl):90S–95SCrossRefGoogle Scholar
  8. 8.
    Villa MT, White LE, Alam M, Yoo SS, Walton RL (2008) Barbed sutures: a review of the literature. Plast Reconstr Surg J 121(3):102e–108eCrossRefGoogle Scholar
  9. 9.
    Kaminer MS, Bogart M, Choi C, Wee SA (2008) Long-term efficacy of anchored barbed sutures in the face and neck. Dermatol Surg 34(8):1041–1047PubMedGoogle Scholar
  10. 10.
    Rosen AD (2010) Use of absorbable running barbed suture and progressive tension technique in abdominoplasty: a novel approach. Plast Reconstr Surg J 125(3):1024–1027CrossRefGoogle Scholar
  11. 11.
    Stephens S, Politi J, Taylor BC (2011) Evaluation of primary total knee arthroplasty incision closure with the use of continuous bidirectional barbed suture. Surg Technol Int XXI:199–203PubMedGoogle Scholar
  12. 12.
    Patel RM, Cayo M, Patel A, Albarillo M, Puri L (2012) Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure. Orthopedics 35(5):e641–e646PubMedCrossRefGoogle Scholar
  13. 13.
    Gililland JM, Anderson LA, Sun G, Erickson JA, Peters CL (2012) Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res 470(1):125–129PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Gililland JM, Anderson LA, Barney JK, Ross HL, Pelt CE, Peters CL (2014) Barbed versus standard sutures for closure in total knee arthroplasty: a multicenter prospective randomized trial. J Arthroplast 29(9 Suppl):135–138CrossRefGoogle Scholar
  15. 15.
    Campbell AL, Patrick DA Jr, Liabaud B, Geller JA (2014) superficial wound closure complications with barbed sutures following knee arthroplasty. J Arthroplast 29(5):966–969CrossRefGoogle Scholar
  16. 16.
    Shermak MA, Mallalieu J, Chang D (2010) Barbed suture impact on wound closure in body contouring surgery. Plast Reconstr Surg 126(5):1735–1741PubMedCrossRefGoogle Scholar
  17. 17.
    Maheswari AV, Naziri Q, Wong A, Burko I, Mont MA, Rasquinha VJ (2015) Barbed sutures in total knee arthroplasty: are these safe, efficacious and cost-effective? J Knee Surg 28(2):151–156Google Scholar
  18. 18.
    Rosen AD (2010) Use of absorbable running barbed suture and progressive tension technique in abdominoplasty: a novel approach. Plast Reconstr Surg 125(3):1024PubMedCrossRefGoogle Scholar
  19. 19.
    Warner JP, Gutowski KA (2009) Abdominoplasty with progressive tension closure using a barbed suture technique. Aesthet Surg J 29:221–225PubMedCrossRefGoogle Scholar
  20. 20.
    Helling ER et al (2007) Complications of facial suspension sutures. Aesthet Surg J 27(2):155PubMedCrossRefGoogle Scholar
  21. 21.
    Wright RC et al (2012) Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty. J Arthroplast 27(7):1413 e1CrossRefGoogle Scholar
  22. 22.
    Ting NT, Moric MM, Della Valle CJ, Levine BR (2012) Use of knotless suture for closure of total hip and knee arthroplasties: a prospective, randomized clinical trial. J Arthroplast 27(10):1783–1788CrossRefGoogle Scholar
  23. 23.
    Schwarkopf R, Hadley S, Weatherall JM, Gross SC, Marvin SE (2012) Barbed sutures for arthroplasty closure—does it decrease the risk of glove perforation? Bull NYU Hosp Jt Dis 70(4):250Google Scholar

Copyright information

© Springer-Verlag France 2015

Authors and Affiliations

  • Sanjay Meena
    • 1
  • Shreesh Gangary
    • 2
  • Pankaj Sharma
    • 1
  • Buddhadev Chowdhury
    • 1
  1. 1.Department of OrthopaedicsAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of OrthopaedicsESI HospitalOkhla, New DelhiIndia

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