Abstract
Surgical site infections constitute the cause of 13% to 18% of readmissions within 90 days of a total hip arthroplasty and are a leading cause of failure of revision total knee arthroplasty. The goals of wound closure are to enhance healing potential, prevent infection, and provide a cosmetic appearance. Traditionally, this has been achieved with the use of interrupted sutures. However, recently “barbed” sutures have been introduced which consist of a solid core with peripheral etched barbs in a helical array. These sutures have been used for both the deep and superficial layers of wound closure in a running fashion with the barbs intended to be self-retaining in the event that the suture is cut or pulls out of the tissue. Proposed advantages include the avoidance of knots, less needles required, improved efficiency, and creation of a “watertight” seal.
Numerous studies have shown decreased times for wound closure with the use of barbed vs. interrupted sutures with no difference in infection or complication rates. With less needles and improved efficiency, there is the potential for cost savings with the use of barbed sutures. However, there have been two studies raising concerns of arthrotomy failure with their use in total knee arthroplasty. In addition, several reports have noted the potential for increased superficial wound complications when barbed sutures are used for a subcutaneous closure. Therefore, what remains clear is that there is no proven, optimal method of wound closure in total joint arthroplasty and that every closure method remains technique dependent.
