Download PDF
J Knee Surg 2021; 34(14): 1516-1526
DOI: 10.1055/s-0040-1710373
Original Article

Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials

Changjiao Sun 
1   Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
,
Lianxu Chen
1   Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
,
Ruiyong Du
1   Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
,
Sha Wu
1   Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
,
Qi Ma
1   Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
,
Xu Cai
1   Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Changping District, Beijing, China
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to August 2019. Finally, we identified 1,472 TKAs (1,270 patients) assessed in 13 randomized-controlled trials. Compared with conventional wound closure techniques, barbed sutures resulted in shorter total wound closure time (p < 0.001), fewer needle puncture injuries to members of the surgical team (p = 0.02). There were no significant differences in terms of blister formation (p = 1.0), superficial infection (p = 0.82), range of motion (p = 0.94), incisional exudate (p = 0.75), suture abscess (p = 0.26), or suture breakage (p = 0.11), wound-related complications (p = 0.10), ecchymosis (p = 0.08) between barbed and conventional wound closure. Based on the available level I evidence, we thus conclude that a knotless barbed suture is a safe and effective approach for wound closure in TKA. Given the relevant possible biases in our meta-analysis, more adequately powered and better-designed randomized-controlled trials studies with long-term follow-up are required to recommend barbed sutures for routine administration in TKA.

Keywords

barbed suture - conventional suture - total knee arthroplasty - wound-related complication

Note

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.




Publication History

Received: 19 November 2019

Accepted: 21 March 2020

Article published online:
27 May 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Chan VWK, Chan PK, Chiu KY, Yan CH, Ng FY. Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomized controlled trial. J Arthroplasty 2017; 32 (05) 1474-1477
    CrossrefPubMedSearch in Google Scholar
  • 2 Khan RJ, Fick D, Yao F. et al. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br 2006; 88 (02) 238-242
    CrossrefPubMedSearch in Google Scholar
  • 3 McKenzie AR. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers. Preliminary report. J Bone Joint Surg Br 1967; 49 (03) 440-447
    CrossrefPubMedSearch in Google Scholar
  • 4 Sah AP. Is there an advantage to knotless barbed suture in TKA wound closure? A randomized trial in simultaneous bilateral TKAs. Clin Orthop Relat Res 2015; 473 (06) 2019-2027
    CrossrefPubMedSearch in Google Scholar
  • 5 Peersman G, Laskin R, Davis J, Peterson MG, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2006; 2 (01) 70-72
    CrossrefPubMedSearch in Google Scholar
  • 6 Vakil JJ, O'Reilly MP, Sutter EG, Mears SC, Belkoff SM, Khanuja HS. Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty 2011; 26 (05) 710-713
    CrossrefPubMedSearch in Google Scholar
  • 7 Nett M, Avelar R, Sheehan M, Cushner F. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. J Knee Surg 2011; 24 (01) 55-59
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Zaruby J, Gingras K, Taylor J, Maul D. An in vivo comparison of barbed suture devices and conventional monofilament sutures for cosmetic skin closure: biomechanical wound strength and histology. Aesthet Surg J 2011; 31 (02) 232-240
    CrossrefPubMedSearch in Google Scholar
  • 9 Villa MT, White LE, Alam M, Yoo SS, Walton RL. Barbed sutures: a review of the literature. Plast Reconstr Surg 2008; 121 (03) 102e-108e
    CrossrefPubMedSearch in Google Scholar
  • 10 Wright RC, Gillis CT, Yacoubian SV, Raven III RB, Falkinstein Y, Yacoubian SV. Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty. J Arthroplasty 2012; 27 (07) 1413.e1-1413.e4
    CrossrefPubMedSearch in Google Scholar
  • 11 Paul MD. Barbed sutures in aesthetic plastic surgery: evolution of thought and process. Aesthet Surg J 2013; 33 (3, Suppl): 17S-31S
    CrossrefPubMedSearch in Google Scholar
  • 12 Kaminer MS, Bogart M, Choi C, Wee SA. Long-term efficacy of anchored barbed sutures in the face and neck. Dermatol Surg 2008; 34 (08) 1041-1047
    PubMedSearch in Google Scholar
  • 13 Rosen AD. Use of absorbable running barbed suture and progressive tension technique in abdominoplasty: a novel approach. Plast Reconstr Surg 2010; 125 (03) 1024-1027
    CrossrefPubMedSearch in Google Scholar
  • 14 Campbell AL, Patrick Jr DA, Liabaud B, Geller JA. Superficial wound closure complications with barbed sutures following knee arthroplasty. J Arthroplasty 2014; 29 (05) 966-969
    CrossrefPubMedSearch in Google Scholar
  • 15 Smith EL, DiSegna ST, Shukla PY, Matzkin EG. Barbed versus traditional sutures: closure time, cost, and wound related outcomes in total joint arthroplasty. J Arthroplasty 2014; 29 (02) 283-287
    CrossrefPubMedSearch in Google Scholar
  • 16 Patel RM, Cayo M, Patel A, Albarillo M, Puri L. Wound complications in joint arthroplasty: comparing traditional and modern methods of skin closure. Orthopedics 2012; 35 (05) e641-e646
    CrossrefPubMedSearch in Google Scholar
  • 17 Chugaev DV, Kornilov NN, Lasunskii SA. [Bidirectional knotless barbed sutures during primary total knee arthroplasty: effective solution or new problem?]. Khirurgiia (Mosk) 2017; 12 (12) 58-65
    PubMedSearch in Google Scholar
  • 18 Gililland JM, Anderson LA, Barney JK, Ross HL, Pelt CE, Peters CL. Barbed versus standard sutures for closure in total knee arthroplasty: a multicenter prospective randomized trial. J Arthroplasty 2014; 29 (9, Suppl): 135-138
    CrossrefPubMedSearch in Google Scholar
  • 19 Li R, Ni M, Zhao J. et al. A modified strategy using barbed sutures for wound closure in total joint arthroplasty: a prospective, randomized, double-blind, self-controlled clinical trial. Med Sci Monit 2018; 24: 8401-8407
    CrossrefPubMedSearch in Google Scholar
  • 20 Malhotra R, Jain V, Kumar V, Gautam D. Evaluation of running knotless barbed suture for capsular closure in primary total knee arthroplasty for osteoarthritis-a prospective randomized study. Int Orthop 2017; 41 (10) 2061-2066
    CrossrefPubMedSearch in Google Scholar
  • 21 Ting NT, Moric MM, Della Valle CJ, Levine BR. Use of knotless suture for closure of total hip and knee arthroplasties: a prospective, randomized clinical trial. J Arthroplasty 2012; 27 (10) 1783-1788
    CrossrefPubMedSearch in Google Scholar
  • 22 Xin P, Wang Y. The analysis and research of risk factors for incision complications after primary total knee arthroplasty. Dissertation, Medical School of Chinses PLA; 2016
    Search in Google Scholar
  • 23 Yan H, Yang C. Effects of different deep incision closure methods on the postoperative recovery of knee arthroplasty. Dissertation, Hubei University for Nationalities; 2018
    Search in Google Scholar
  • 24 Zhao H, Yin Q, Liu W, Liu S, Xiao S, Wang S. Application of a novel barbed suture in wound closure of hip and knee replacement. Shandong Daxue Xuebao Yixue Ban 2015; 53 (08) 53-56
    PubMedSearch in Google Scholar
  • 25 Zhao G, Ma J, Wang Z, Xiao L. Randomized controlled study of barbed suture in primary total knee arthroplasty. Journal of Practical Orthopaedics. 2017; 23 (09) 827-829
    PubMedSearch in Google Scholar
  • 26 Meena S, Gangary S, Sharma P, Chowdhury B. Barbed versus standard sutures in total knee arthroplasty: a meta-analysis. Eur J Orthop Surg Traumatol 2015; 25 (06) 1105-1110
    CrossrefPubMedSearch in Google Scholar
  • 27 Zhang W, Xue D, Yin H. et al. Barbed versus traditional sutures for wound closure in knee arthroplasty: a systematic review and meta-analysis. Sci Rep 2016; 6: 19764 . Doi: 10.1038/srep19764
    CrossrefPubMedSearch in Google Scholar
  • 28 Xin WQ, Zhao Y, Wang H. et al. A better strategy using barbed sutures for wound closure in total knee arthroplasty. J Comp Eff Res 2019; 8 (10) 799-814
    CrossrefPubMedSearch in Google Scholar
  • 29 Gamba C, Hinarejos P, Serrano-Chinchilla P. et al. Barbed sutures in total knee arthroplasty: are they really useful? A randomized controlled trial. J Knee Surg 2019. Doi: 10.1055/s-0039-1688922
  • 30 Eickmann T, Quane E. Total knee arthroplasty closure with barbed sutures. J Knee Surg 2010; 23 (03) 163-167
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Gililland JM, Anderson LA, Sun G, Erickson JA, Peters CL. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res 2012; 470 (01) 125-129
    CrossrefPubMedSearch in Google Scholar
  • 32 Maheshwari AV, Naziri Q, Wong A, Burko I, Mont MA, Rasquinha VJ. Barbed sutures in total knee arthroplasty: are these safe, efficacious, and cost-effective?. J Knee Surg 2015; 28 (02) 151-156
    PubMedSearch in Google Scholar
  • 33 Krebs VE, Elmallah RK, Khlopas A. et al. Wound closure techniques for total knee arthroplasty: an evidence-based review of the literature. J Arthroplasty 2018; 33 (02) 633-638
    CrossrefPubMedSearch in Google Scholar
  • 34 Kobayashi S, Niki Y, Harato K, Udagawa K, Matsumoto M, Nakamura M. The effects of barbed suture on watertightness after knee arthrotomy closure: a cadaveric study. J Orthop Surg Res 2018; 13 (01) 323 . Doi: 10.1186/s13018-018-1035-3
    CrossrefPubMedSearch in Google Scholar
  • 35 Macario A. What does one minute of operating room time cost?. J Clin Anesth 2010; 22 (04) 233-236
    CrossrefPubMedSearch in Google Scholar