Comparative study on effectiveness of intermittent suture versus cosmetic suture in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Shuiqing , CHEN Liang , ZENG Min , XIE Jie ,  HU Yihe

Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, 410000, P.R.China;

Corresponding author：

HU Yihe, Email: xy_huyh@163.com

Keywords：

Total knee arthroplasty; incision suture; intermittent suture; cosmetic suture; periprosthetic joint infection

DOI：

10.7507/1002-1892.201811066

Video：

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Objective To compare the effectiveness of the intermittent suture and the cosmetic suture in total knee arthroplasty (TKA). Methods A clinical data of 48 patients with knee osteoarthritis, who underwent initial TKA between January 2017 and April 2018, was retrospectively analyzed. Among them, 23 patients underwent intermittent suture (group A) and 25 patients underwent cosmetic suture (group B). There was no significant difference in gender, age, body mass index, disease duration, degrees of varus and valgus deformities, knee society score (KSS), visual analogue scale (VAS) score, and levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in serum before operation between the two groups (P>0.05). KSS scores at 1 and 6 months after operation were used to assess the knee function. VAS scores at 1, 3, and 5 days after operation were used to assess the pain degree of knee. Levels of IL-6, PCT, CRP, and ESR in serum at 1 day and 1 month after operation were recorded to evaluate the risk of periprosthetic infection. Likert score at 6 months after operation was used to evaluate the satisfaction of incision. The hospitalization time after operation was also recorded. Results All patients were followed up 7- 17 months (mean, 11.3 months). There was no significant difference in hospitalization time after operation between two groups (t=−1.907, P=0.063). The Likert score in group A was significantly lower than that in group B (t=−2.196, P=0.033). The VAS score, KSS clinical score and KSS functional score at different time points after operation were significantly better than those before operation in two groups (P<0.05). The VAS score at 5 days after operation was better than that at 1 day after operation in two groups, and the KSS clinical score and KSS functional score at 6 months after operation were better than those at 1 month after operation in two groups, all showing significant differences (P<0.05). The VAS scores at 3 and 5 days after operation were significantly lower in group B than in group A (P<0.05), and there was no significant difference in VAS score and KSS scores between two groups at other time points after operation (P>0.05). There was no significant difference in the levels of IL-6, PCT, CRP, and ESR between the two groups at different time points after operation (P>0.05). Conclusion Cosmetic suture is superior to intermittent suture in incision appearance and pain management, but there is no significant difference in short-term joint function and risk of periprosthetic infection after TKA.

Citation： HU Shuiqing, CHEN Liang, ZENG Min, XIE Jie, HU Yihe. Comparative study on effectiveness of intermittent suture versus cosmetic suture in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1121-1126. doi: 10.7507/1002-1892.201811066 Copy

1.	郭保逢, 秦泗河, 黄野. 膝关节骨关节炎的保膝治疗进展. 中国修复重建外科杂志, 2018, 32(10): 1292-1296.
2.	张星火, A. T. Wild, 于振山, 等非置换髌骨的非骨水泥型全膝关节置换术中期疗效. 中国修复重建外科杂志, 2008, 22(6): 669-672.
3.	黄小敬, 杨胜武, 袁健东. 髋膝关节置换术后假体周围感染的危险因素分析. 中华医院感染学杂志, 2014, 24(6): 1471-1473.
4.	彭开勤. 切口愈合的影响因素. 临床外科杂志, 2007, 15(9): 588-589.
5.	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(6): 2019-2027.
6.	Newman JT, Morgan SJ, Resende GV, et al. Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients. Patient Saf Surg, 2011, 5(1): 26.
7.	Smith EL, DiSegna ST, Shukla PY, et al. Barbed versus traditional sutures: closure time, cost, and wound related outcomes in total joint arthroplasty. J Arthroplasty, 2014, 29(2): 283-287.
8.	Maheshwari AV, Naziri Q, Wong A, et al. Barbed sutures in total knee arthroplasty: are these safe, efficacious, and cost-effective? J Knee Surg, 2015, 28(2): 151-156.
9.	韦健, 洪定钢. 膝关节置换术患者不同缝合方式对伤口愈合影响的研究. 中国骨与关节杂志, 2016, 5(12): 900-903.
10.	Songu M, Aslan H, Denizoglu I, et al. Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results. Acta Otolaryngol, 2013, 133(11): 1201-1206.
11.	王亚飞, 李红喜, 廉永云, 等. 运动体位下间断缝合在人工全膝关节置换术中的应用研究. 中国修复重建外科杂志, 2018, 32(4): 400-405.
12.	吕增亮, 葛武. 髋膝关节置换术后假体周围感染的危险因素分析. 中国临床研究, 2015, 28(11): 1496-1497.
13.	Boddapati V, Fu MC, Mayman DJ, et al. Revision total knee arthroplasty for periprosthetic joint infection is associated with increased postoperative morbidity and mortality relative to noninfectious revisions. J Arthroplasty, 2018, 33(2): 521-526.
14.	Ro DH, Kim JK, Kim S, et al. Periprosthetic joint infection does not preclude good outcomes after a revision total knee arthroplasty: a 7-year follow-up study of 144 retrospective cases. Biomed Res Int, 2018, 2018: 2582140.
15.	Monticone M, Ferrante S, Rocca B, et al. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(2): 231-239.
16.	李玉龙, 翁习生, 董玉雷. 老年全膝关节置换术围手术期并发症影响因素的研究进展. 中华老年骨科与康复电子杂志, 2016, 2(3): 177-180.
17.	曹光磊, 沈惠良, 安帅, 等. 高龄患者人工全膝关节置换术的并发症及疗效分析. 中华关节外科杂志(电子版), 2015, (1): 50-54.
18.	孙铁莉. 妇科腹部皮肤纵切口缝线选择的探讨. 中国实用医药, 2015, 10(26): 85-86.
19.	郭彩霞. 使用 2-0 可吸收线会阴切口皮下美容缝合与传统丝线缝合对产妇康复的影响. 实用妇科内分泌电子杂志, 2015, 2(5): 51-52.
20.	伍明. 可吸收线（快薇乔 4/0）连续缝合家兔头皮与普通慕丝线（4/0）间断缝合的优劣对照研究. 长沙: 中南大学, 2007.
21.	Amend B, Muller O, Bedke J, et al. Biomechanical proof of barbed sutures for the efficacy of laparoscopic pyeloplasty. J Endourol, 2012, 26(5): 540-544.
22.	Nett M, Avelar R, Sheehan M, et al. 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(1): 55-59.
23.	程飚, 付小兵, 盛志勇. 免疫因素在瘢痕形成和发展中的作用. 中国临床康复, 2002, 6(4): 472-473, 486.
24.	Yuan K, Li WD, Qiang Y, et al. Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty. Surg Infect (Larchmt), 2015, 16(2): 146-150.
25.	黄强开, 杜少华, 卫小春, 等. 白介素-6 对于早期诊断关节置换术后假体周围感染的意义. 中华关节外科杂志(电子版), 2012, 6(3): 74-76.
26.	郭旗, 郑稼, 金毅, 等. 血沉、C 反应蛋白及 ECT 联合诊断假体周围感染临床研究. 中华实用诊断与治疗杂志, 2010, 24(3): 255-257.
27.	Bouaicha S, Blatter S, Moor BK, et al. Early serum procalcitonin level after primary total hip replacement. Mediators Inflamm, 2013, 2013: 927636.

1. 郭保逢, 秦泗河, 黄野. 膝关节骨关节炎的保膝治疗进展. 中国修复重建外科杂志, 2018, 32(10): 1292-1296.
2. 张星火, A. T. Wild, 于振山, 等非置换髌骨的非骨水泥型全膝关节置换术中期疗效. 中国修复重建外科杂志, 2008, 22(6): 669-672.
3. 黄小敬, 杨胜武, 袁健东. 髋膝关节置换术后假体周围感染的危险因素分析. 中华医院感染学杂志, 2014, 24(6): 1471-1473.
4. 彭开勤. 切口愈合的影响因素. 临床外科杂志, 2007, 15(9): 588-589.
5. 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(6): 2019-2027.
6. Newman JT, Morgan SJ, Resende GV, et al. Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients. Patient Saf Surg, 2011, 5(1): 26.
7. Smith EL, DiSegna ST, Shukla PY, et al. Barbed versus traditional sutures: closure time, cost, and wound related outcomes in total joint arthroplasty. J Arthroplasty, 2014, 29(2): 283-287.
8. Maheshwari AV, Naziri Q, Wong A, et al. Barbed sutures in total knee arthroplasty: are these safe, efficacious, and cost-effective? J Knee Surg, 2015, 28(2): 151-156.
9. 韦健, 洪定钢. 膝关节置换术患者不同缝合方式对伤口愈合影响的研究. 中国骨与关节杂志, 2016, 5(12): 900-903.
10. Songu M, Aslan H, Denizoglu I, et al. Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results. Acta Otolaryngol, 2013, 133(11): 1201-1206.
11. 王亚飞, 李红喜, 廉永云, 等. 运动体位下间断缝合在人工全膝关节置换术中的应用研究. 中国修复重建外科杂志, 2018, 32(4): 400-405.
12. 吕增亮, 葛武. 髋膝关节置换术后假体周围感染的危险因素分析. 中国临床研究, 2015, 28(11): 1496-1497.
13. Boddapati V, Fu MC, Mayman DJ, et al. Revision total knee arthroplasty for periprosthetic joint infection is associated with increased postoperative morbidity and mortality relative to noninfectious revisions. J Arthroplasty, 2018, 33(2): 521-526.
14. Ro DH, Kim JK, Kim S, et al. Periprosthetic joint infection does not preclude good outcomes after a revision total knee arthroplasty: a 7-year follow-up study of 144 retrospective cases. Biomed Res Int, 2018, 2018: 2582140.
15. Monticone M, Ferrante S, Rocca B, et al. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(2): 231-239.
16. 李玉龙, 翁习生, 董玉雷. 老年全膝关节置换术围手术期并发症影响因素的研究进展. 中华老年骨科与康复电子杂志, 2016, 2(3): 177-180.
17. 曹光磊, 沈惠良, 安帅, 等. 高龄患者人工全膝关节置换术的并发症及疗效分析. 中华关节外科杂志(电子版), 2015, (1): 50-54.
18. 孙铁莉. 妇科腹部皮肤纵切口缝线选择的探讨. 中国实用医药, 2015, 10(26): 85-86.
19. 郭彩霞. 使用 2-0 可吸收线会阴切口皮下美容缝合与传统丝线缝合对产妇康复的影响. 实用妇科内分泌电子杂志, 2015, 2(5): 51-52.
20. 伍明. 可吸收线（快薇乔 4/0）连续缝合家兔头皮与普通慕丝线（4/0）间断缝合的优劣对照研究. 长沙: 中南大学, 2007.
21. Amend B, Muller O, Bedke J, et al. Biomechanical proof of barbed sutures for the efficacy of laparoscopic pyeloplasty. J Endourol, 2012, 26(5): 540-544.
22. Nett M, Avelar R, Sheehan M, et al. 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(1): 55-59.
23. 程飚, 付小兵, 盛志勇. 免疫因素在瘢痕形成和发展中的作用. 中国临床康复, 2002, 6(4): 472-473, 486.
24. Yuan K, Li WD, Qiang Y, et al. Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty. Surg Infect (Larchmt), 2015, 16(2): 146-150.
25. 黄强开, 杜少华, 卫小春, 等. 白介素-6 对于早期诊断关节置换术后假体周围感染的意义. 中华关节外科杂志(电子版), 2012, 6(3): 74-76.
26. 郭旗, 郑稼, 金毅, 等. 血沉、C 反应蛋白及 ECT 联合诊断假体周围感染临床研究. 中华实用诊断与治疗杂志, 2010, 24(3): 255-257.
27. Bouaicha S, Blatter S, Moor BK, et al. Early serum procalcitonin level after primary total hip replacement. Mediators Inflamm, 2013, 2013: 927636.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on effectiveness of intermittent suture versus cosmetic suture in total knee arthroplasty

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