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Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial

  • Knee Revision Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The use of barbed sutures for wound closure in primary total joint arthroplasty (TJA) has been shown to be effective and safe. However, their effectiveness and safety in revision TJA procedures has not been thoroughly studied. This study aims to evaluate the efficacy and safety of using barbed suture closure in revision TJA setting.

Methods

A total of 80 patients undergoing revision TJA between September 2020 and November 2022 were included in this randomized controlled trial study. Following informed consent, patients were computer-randomized to the treatment arm (barbed suture wound closure) or to the control arm (conventional wound closure). Closure duration, closure rate, number of sutures used and wound related outcomes including complication rates and Patient and Observer Scar Assessment Scale (POSAS) score were compared between groups.

Results

The use of barbed sutures decreased closure time by 6 min (30.1 vs. 36.1 min, P = 0.008) with a higher wound closure rate (6.5 vs. 5.5 mm/minute, P = 0.013). Additionally, the number of sutures used for wound closure in the barbed group was significantly lower than in the control group (6.2 vs. 10.1, respectively, P < 0.001). There were no significant differences in the rate of postoperative wound complications (P = 0.556) or patient and observer POSAS scores (P = 0.211, P = 297, respectively) between the two groups at 3-month follow-up.

Conclusion

Closure of revision TJA surgical wound utilizing barbed sutures reduced closure time and the number of needles handled by operative staff, with no significant increase in intra- or post-operative complications rate when compared to traditional closure technique.

Level of Evidence

I.

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Funding

This research was conducted with support by the Investigator-Initiated Study Program (Grant #WC-2019-05) by ETHICON, Inc.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Langone Health, NewYork, NY, USA

    Itay Ashkenazi, Walter D. Sobba, Jessica S. Morton, Thomas Bieganowski, Ittai Shichman & Ran Schwarzkopf

  2. Division of Orthopaedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Itay Ashkenazi & Ittai Shichman

Authors
  1. Itay Ashkenazi
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  2. Walter D. Sobba
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  3. Jessica S. Morton
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  4. Thomas Bieganowski
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  5. Ittai Shichman
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  6. Ran Schwarzkopf
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Corresponding author

Correspondence to Ran Schwarzkopf.

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Ethical approval

This study received institutional review board (IRB) approval at our institution: i20-00280. All participants signed informed consent forms before engaging in any study activities.

Conflict of interest

IA, WDS, JM, TB, and IS have nothing to disclose.

RS reports IP royalties from Smith & Nephew, being paid consultant for Smith & Nephew, Zimmer and Intellijoint, have stock options from intellijoint, Gauss Surgical and PSI, and receives research support from Smith & Nephew and Intellijoint.

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Ashkenazi, I., Sobba, W.D., Morton, J. et al. Knotless suture in revision total joint arthroplasty: a prospective randomized controlled trial. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05283-9

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