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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
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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

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