Barbed sutures more efficient in TKA wound closure compared to standard sutures .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(2):1 Clin Orthop Relat Res. 2015 Jun;473(6):2019-2750 patients undergoing bilateral total knee arthroplasty (TKA) were randomly assigned to undergo closure with knotless bidirectional barbed sutures in one knee and standard sutures in the other. The purpose of this study was to determine whether there is a superior technique in terms of clinical outcomes and cost-effectiveness. Findings of this study determined knotless bidirectional barbed sutures to be more effective for closure time and direct operative cost compared to standard sutures. However, Knee Society Scores, range of motion (ROM), and wound appearance were comparable between methods.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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Randomization
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Outcome Measurements
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Inclusion / Exclusion
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Therapy Description
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Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
In total knee arthroplasty, wound closure is necessary to minimize postoperative wound complications and to withstand forces in order to prevent reopening of the incision during early knee motion. Cadaver model trials and biomechanical testing have suggested that knotless bidirectional barbed sutures have greater efficacy in providing sufficient wound closure and a higher resistance to failure when compared with standard sutures. However, previous studies have reported more prevalent postoperative wound complications in this method, and therefore, the relevance of bidirectional barbed sutures is still under debate. Thus, the present study was designed to determine an optimal approach to wound closure in TKA by using bilateral TKA patients.
Was war die wichtigste Forschungsfrage?
Are knotless bidirectional barbed sutures superior to standard sutures in terms of wound closure and the resulting clinical and cost outcomes in bilateral total knee arthroplasty, when assessed up to 1 year postoperatively?
- Wound closure time was significantly faster in the barbed suture group (11.4 +/- 2.2 minutes) compared to the standard suture group (16.1 +/- 2.2 minutes) (Meantime diff: 4.7 +/- 2.8 minutes 95% CI -5.5 to -3.7; p<0.001)
- No significant differences were found in overall tourniquet time between both groups (barbed: 78.7 +/- 11.1 minutes; standard: 74.9 +/- 10.1 minutes; p=0.11)
- Wound complications were comparable between the two approaches
- Number of suture handoffs were significantly less with barbed sutures (7 - 9) compared to standard sutures (14 - 16) (p<0.001)
- Significantly more suture breakages and premature disengagements were seen using the standard approach compared to the barbed approach (3 suture breakages and 5 premature disengagements compared to none in the barbed approach; p<0.005)
- No significant differences were seen between groups when assessing ROM before discharge (barbed mean: 100.2 +/- 7.59 deg., standard mean: 99.8 +/- 15.43 deg.; 95% CI -4.47 to 5.28; p=0.8) or at 1 year follow-up (barbed mean: 126.7 +/- 6.9 deg., standard mean: 125.6 +/- 7.0 deg.; 95% CI -3.77 to 1.73; p=0.4)
- Knee Society knee scores were comparable between both barbed and standard groups at 3 months follow-up (barbed mean: 89.2 +/- 7.27, standard mean: 90.4 +/- 5.79; 95% CI, 23.84 to 1.43; p=0.37) and at 1-year follow-up (barbed mean: 92.8 +/- 6.69, standard mean: 93.3 +/- 6.2; 95% CI, 21.97 to 3.36; p = 0.6)
- Material costs of barbed sutures were higher than standard sutures, however; barbed sutures were cost beneficial in faster wound closure and reduction in operating room time
Was sollte ich mir besonders merken?
Significantly faster wound closure time was seen in knotless bidirectional barbed sutures compared to standard sutures in bilateral total knee arthroplasty patients. Additionally, barbed sutures were found to be more efficient in direct cost. No differences in the range of motion or Knee Society knee scores were seen between wound closure approaches.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Knotless bidirectional barbed sutures were determined to have greater efficacy with relation to wound closure time and lower direct operative costs compared to standard sutures in TKA. However, results were comparable between the two suture methods when measured for range of motion and Knee Society knee scores. Further studies with larger population sizes should be conducted to yield more conclusive results.
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