The efficacy of absorbable barbed suture <i>versus</i> traditional absorbable suture in total knee arthroplasty: a meta-analysis _Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yafei , LIAO Yunjian , LIU Huimin , ZHANG Zhitao , LI Hongxi , DAI Daifeng , DONG Feng ,  LIAN Yongyun

Fourth Affiliated Hospital of Harbin Medical University, Harbin, 150000, P.R.China;

Corresponding author：

LIAN Yongyun, Email: liandadong@163.com

Keywords：

Absorbable barbed suture; Traditional absorbable suture; Total knee arthroplasty; Systematic review; Meta-analysis; Clinical trial; Suture time of joint capsule; Complication

DOI：

10.7507/1672-2531.201801075

Video：

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ObjectivesTo systematically review the efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty (TKA).MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect clinical trials of absorbable barbed suture versus traditional absorbable suture in TKA from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 6 randomized controlled trials (RCTs) and 5 cohort studies were included, involving 2 008 patients. Meta-analysis showed that the joint capsule suture time of the absorbable barbed suture group [MD=–4.31, 95% CI (–4.72, –3.90), P<0.000 01], the incidence of acupuncture injury during suture [OR=0.14, 95% CI (0.03, 0.61),P=0.009], and incision complication rate [OR=0.56, 95% CI (0.36, 0.88), P=0.01] were significantly lower than the traditional absorbable suture group, but the incidence of suture fracture [OR=23.03, 95% CI (3.08, 172.09),P=0.002] was higher, yet the difference was statistically significant. There were no significant differences in the incidence of superficial infection, deep infection, aseptic redness, incision dehiscence and KSS score at 3 months after operation (P>0.05).ConclusionsAvailable evidence suggests that the use of absorbable barbed sutures to close the TKA surgical incision shortens the time to suture the joint capsule, reduces the incidence of acupuncture injury as well as the overall incidence of incision complications without increasing superficial infection, deep infection, and sterility. The incidence of redness and incision splitting has no significant effects on joint function at 3 months after surgery, however the incidence of suture fracture is higher. Due to limited quality and quantity of the included studies, the above conclusions are required to be verified by more high-quality studies.

Citation： WANG Yafei, LIAO Yunjian, LIU Huimin, ZHANG Zhitao, LI Hongxi, DAI Daifeng, DONG Feng, LIAN Yongyun. The efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty: a meta-analysis . Chinese Journal of Evidence-Based Medicine, 2018, 18(10): 1101-1108. doi: 10.7507/1672-2531.201801075 Copy

1.	陈曦, 吕厚山. 全膝关节置换术后翻修的研究进展. 中华骨科杂志, 2011, 31(9): 993-996.
2.	Cooper HJ, Bas MA. Closed-incision negative-pressure therapy versus antimicrobial dressings after revision hip and knee surgery: a comparative study. J Arthroplasty, 2016, 31(5): 1047-1052.
3.	Valero R, Schatloff O, Chauhan S, et al. Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy. Actas Urol Esp, 2012, 36(2): 69-74.
4.	Vakil JJ, O'Reilly MP, Sutter EG, et al. Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty, 2011, 26(5): 710-713.
5.	Meena S, Gangary S, Sharma P, et al. Barbed versus standard sutures in total knee arthroplasty: a meta-analysis. Eur J Orthop Surg Traumatol, 2015, 25(6): 1105-1110.
6.	Wright RC, Gillis CT, Yacoubian SV, et al. Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty. J Arthroplasty, 2012, 27(7): 1413, e1-e4.
7.	安光辉, 赵毅, 姚斐, 等. 脊柱推拿治疗腰背及颈部疼痛的疗效和安全性的系统评价再评价. 中国循证医学杂志, 2015, 15(9): 1010-1017.
8.	赵光辉, 马建兵, 王志远, 等. 倒刺缝线在初次全膝关节置换术中的随机对照研究. 实用骨科杂志, 2017, 23(9): 827-829.
9.	张卓, 周勇刚, 林峰, 等. 可吸收倒刺缝合线在人工全膝关节置换术中应用的病例对照研究. 中国骨伤, 2016, 29(9): 809-813.
10.	瓦热斯江•尼牙孜, 赵巍, 米尔阿里木•木尔提扎, 等. 双向锯齿缝线在人工全膝关节置换术中的应用. 生物骨科材料与临床研究, 2015, 12(2): 56-59.
11.	辛鹏, 倪明, 张国强, 等. 初次关节置换术双向倒刺缝线关闭切口的临床对照研究. 中华保健医学杂志, 2015, 17(6): 446-450.
12.	Malhotra R, Jain V, Kumar V, et al. 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.
13.	Gililland JM, Anderson LA, Barney JK, et al. Barbed versus standard sutures for closure in total knee arthroplasty: a multicenter prospective randomized trial. J Arthroplasty, 2014, 29(9 Suppl): 135-138.
14.	Alexander SP. Is there an advantage to knotless barbed suture in TKA wound closure? A randomized trial in simultaneous bilateral TKAs. Clin Orthop Relat R, 2015, 473(6): 2019.
15.	Eickmann T, Quane E. Total knee arthroplasty closure with barbed sutures. J Knee Surg, 2010, 23(3): 163-167.
16.	Vincent WK, Chan PK, Chiu KY, et al. Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomized controlled trial. J Arthroplasty, 2016, 32(5): 1474-1477.
17.	Jeremy GM, Anderson LA, Sun G, et al. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res, 2012, 470(1): 125-129.
18.	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.
19.	Dignon A, Arnett N. Which is the better method of wound closure in patients undergoing hip or knee replacement surgery: sutures or skin clips? J Perioper Pract, 2013, 23(4): 72-76.
20.	赵恒, 殷庆丰, 刘文广, 等. 新型倒刺缝线在髋膝关节置换深层组织缝合中的应用. 山东大学学报(医学版), 2015, 53(8): 53-56.
21.	Campbell AL, Patrick DA Jr, Liabaud B, et al. Superficial wound closure complications with barbed sutures following knee arthroplasty. J Arthroplasty, 2014, 29(5): 966-969.
22.	Austin DC, Keeney BJ, Dempsey BE, et al. Are barbed sutures associated with 90-day reoperation rates after primary TKA? Clin Orthop Relat R, 2017, (9 suppl): 1-11.
23.	Stanton T. Study: barbed sutures show advantages in TKA. Aaos Now, 2014, 8(1): 10.
24.	Helling ER, Okpaku A, Wang PT, et al. Complications of facial suspension sutures. Aesthet Surg J, 2007, 27(2): 155-161.
25.	Shermak MA. The application of barbed sutures in body contouring surgery. Aesthet Surg J, 2013, 33(3 Suppl): 72S-75S.
26.	Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am, 2013, 95(9): 775-782.
27.	Clemente A, Bergamin F, Surace C, et al. Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. J Orthop Traumatol, 2015, 16(3): 251-257.
28.	Yang Y, Yang SB, Wang YG, et al. Bacterial inhibition potential of quaternised chitosan-coated VICRYL absorbable suture: An invitro, and invivo, study. J Orthop Transl, 2017, 8(C): 49-61.
29.	Ramon Y. SMAS plication with absorbable barbed sutures: safe, fast and simple approach. Plast Reconstr Surg, 2014, 134(1): 102.
30.	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.
31.	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.
32.	Gözen AS, Arslan M, Schulze M, et al. Comparison of laparoscopic closure of the bladder with barbed polyglyconate versus polyglactin suture material in the pig bladder model: an experimental in vitro study. J Endourol, 2012, 26(6): 732-736.

1. 陈曦, 吕厚山. 全膝关节置换术后翻修的研究进展. 中华骨科杂志, 2011, 31(9): 993-996.
2. Cooper HJ, Bas MA. Closed-incision negative-pressure therapy versus antimicrobial dressings after revision hip and knee surgery: a comparative study. J Arthroplasty, 2016, 31(5): 1047-1052.
3. Valero R, Schatloff O, Chauhan S, et al. Bidirectional barbed suture for bladder neck reconstruction, posterior reconstruction and vesicourethral anastomosis during robot assisted radical prostatectomy. Actas Urol Esp, 2012, 36(2): 69-74.
4. Vakil JJ, O'Reilly MP, Sutter EG, et al. Knee arthrotomy repair with a continuous barbed suture: a biomechanical study. J Arthroplasty, 2011, 26(5): 710-713.
5. Meena S, Gangary S, Sharma P, et al. Barbed versus standard sutures in total knee arthroplasty: a meta-analysis. Eur J Orthop Surg Traumatol, 2015, 25(6): 1105-1110.
6. Wright RC, Gillis CT, Yacoubian SV, et al. Extensor mechanism repair failure with use of bidirectional barbed suture in total knee arthroplasty. J Arthroplasty, 2012, 27(7): 1413, e1-e4.
7. 安光辉, 赵毅, 姚斐, 等. 脊柱推拿治疗腰背及颈部疼痛的疗效和安全性的系统评价再评价. 中国循证医学杂志, 2015, 15(9): 1010-1017.
8. 赵光辉, 马建兵, 王志远, 等. 倒刺缝线在初次全膝关节置换术中的随机对照研究. 实用骨科杂志, 2017, 23(9): 827-829.
9. 张卓, 周勇刚, 林峰, 等. 可吸收倒刺缝合线在人工全膝关节置换术中应用的病例对照研究. 中国骨伤, 2016, 29(9): 809-813.
10. 瓦热斯江•尼牙孜, 赵巍, 米尔阿里木•木尔提扎, 等. 双向锯齿缝线在人工全膝关节置换术中的应用. 生物骨科材料与临床研究, 2015, 12(2): 56-59.
11. 辛鹏, 倪明, 张国强, 等. 初次关节置换术双向倒刺缝线关闭切口的临床对照研究. 中华保健医学杂志, 2015, 17(6): 446-450.
12. Malhotra R, Jain V, Kumar V, et al. 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.
13. Gililland JM, Anderson LA, Barney JK, et al. Barbed versus standard sutures for closure in total knee arthroplasty: a multicenter prospective randomized trial. J Arthroplasty, 2014, 29(9 Suppl): 135-138.
14. Alexander SP. Is there an advantage to knotless barbed suture in TKA wound closure? A randomized trial in simultaneous bilateral TKAs. Clin Orthop Relat R, 2015, 473(6): 2019.
15. Eickmann T, Quane E. Total knee arthroplasty closure with barbed sutures. J Knee Surg, 2010, 23(3): 163-167.
16. Vincent WK, Chan PK, Chiu KY, et al. Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomized controlled trial. J Arthroplasty, 2016, 32(5): 1474-1477.
17. Jeremy GM, Anderson LA, Sun G, et al. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res, 2012, 470(1): 125-129.
18. 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.
19. Dignon A, Arnett N. Which is the better method of wound closure in patients undergoing hip or knee replacement surgery: sutures or skin clips? J Perioper Pract, 2013, 23(4): 72-76.
20. 赵恒, 殷庆丰, 刘文广, 等. 新型倒刺缝线在髋膝关节置换深层组织缝合中的应用. 山东大学学报(医学版), 2015, 53(8): 53-56.
21. Campbell AL, Patrick DA Jr, Liabaud B, et al. Superficial wound closure complications with barbed sutures following knee arthroplasty. J Arthroplasty, 2014, 29(5): 966-969.
22. Austin DC, Keeney BJ, Dempsey BE, et al. Are barbed sutures associated with 90-day reoperation rates after primary TKA? Clin Orthop Relat R, 2017, (9 suppl): 1-11.
23. Stanton T. Study: barbed sutures show advantages in TKA. Aaos Now, 2014, 8(1): 10.
24. Helling ER, Okpaku A, Wang PT, et al. Complications of facial suspension sutures. Aesthet Surg J, 2007, 27(2): 155-161.
25. Shermak MA. The application of barbed sutures in body contouring surgery. Aesthet Surg J, 2013, 33(3 Suppl): 72S-75S.
26. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am, 2013, 95(9): 775-782.
27. Clemente A, Bergamin F, Surace C, et al. Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. J Orthop Traumatol, 2015, 16(3): 251-257.
28. Yang Y, Yang SB, Wang YG, et al. Bacterial inhibition potential of quaternised chitosan-coated VICRYL absorbable suture: An invitro, and invivo, study. J Orthop Transl, 2017, 8(C): 49-61.
29. Ramon Y. SMAS plication with absorbable barbed sutures: safe, fast and simple approach. Plast Reconstr Surg, 2014, 134(1): 102.
30. 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.
31. 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.
32. Gözen AS, Arslan M, Schulze M, et al. Comparison of laparoscopic closure of the bladder with barbed polyglyconate versus polyglactin suture material in the pig bladder model: an experimental in vitro study. J Endourol, 2012, 26(6): 732-736.

Chinese Journal of Evidence-Based Medicine

The efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty: a meta-analysis

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