Analysis of Standard Versus Barbed Sutures in Primary Total Knee Arthroplasty.
Condition: Arthropathy of Knee
MeSH terms: Joint Diseases
Study type: Observational

Summary: 
      The purpose of this prospective study is determine if barbed sutures are more efficient, have
      comparable complication rates, clinical outcomes, and cosmesis outcomes versus traditional
      knotted sutures when used in the closure of primary total knee arthroplasty (TKA).

      Barbed suture has been associated with improved closure efficiency and safety in TKA in prior
      studies. The investigators performed a multicenter randomized controlled trial to determine
      the efficiency and safety of this technology in TKA. The investigators prospectively
      randomized 411 patients undergoing primary TKA to either barbed running (n=191) or knotted
      interrupted suture closure (n=203). Closure time was measured intraoperatively. Cost analysis
      was based on suture and operating room time costs.
    

Detailed description: 
      Total knee arthroplasty (TKA) rates have consistently risen in recent years, and demand is
      expected to increase by over 600% in the next 20 years. Decreasing reimbursement and
      available resources make tangible advances in surgical efficiency and outcomes essential in
      meeting current and future demand. Closure time may be one of the best targets in the push to
      reduce operative time and cost while increasing operative productivity. Optimizing lengthy,
      multilayered wound closures in TKA is a promising means for improving both efficiency and
      outcomes by potentially decreasing wound closure time, reducing postoperative wound
      complications, and improving cosmetic outcomes.

      Running knotless suture technique utilizing barbed suture technology has recently been shown
      to reduce wound closure time in both total hip and knee arthroplasty in a small, prospective,
      randomized clinical trial. Barbed suture technology has also facilitated rapid closure and
      soft-tissue repair in plastic-surgery literature. Very few studies have reported on the use
      of barbed suture technology for multilayered closure in orthopedics. As a pilot study, the
      investigators performed a retrospective analysis of consecutive cohorts before and after
      changing to barbed suture. The investigators believed that our published slight improvement
      in efficiency and cost savings of a barbed suture closure was underestimated due to the
      retrospective nature of our pilot study and the investigators therefore elected to proceed
      forward with a prospective randomized trial. Additionally, in the investigators pilot study
      we found a potential trend toward lower wound complications with the barbed suture and we
      wanted to see if this would be borne out in a prospective randomized trial.

      The investigators hypothesized that a prospective study would show that barbed sutures would
      be more efficient, have comparable complication rates, clinical outcomes, and cosmesis
      outcomes versus traditional knotted sutures when used in the closure of primary TKA.
      Specifically, the investigators hypotheses were as follows: multilayered closure in TKA with
      barbed suture would be associated with (1) shorter closure times; (2) lower cost; (3) similar
      closure related perioperative complication rates; and (4) similar Knee Society, cosmesis, and
      patient satisfaction scores when compared to standard knotted suture closure.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        The study and control groups will be made up of consecutive patients undergoing a median
        parapatellar approach primary total knee arthroplasty at the University of Utah Hospital
        and Clinics. The control group will undergo two-layer closure utilizing a standard
        interrupted, knotted suture technique. The closures will be performed by 2 members of the
        team (attending surgeon, resident, fellow, or PA) in ALL closures so as to limit the
        possible confounder of closure time variation due to different numbers of people closing
        the incision. This will specifically consist of arthrotomy closure using interrupted #1
        Ethibond™ in figure of eight fashion and sudermal closure using 2-0 Monocryl™ in
        interrupted buried fashion.
      
Keywords: barbed sutures; knotted sutures; total knee arthroplasty; knee surgery