Skin Closure Using Barbed Sutures Improves Patient Satisfaction With Wound Healing Compared to Interrupted Sutures in Total Knee Arthroplasty: A Prospective Single-Blind Randomized Controlled Trial.

Abstract

Few studies have quantitatively assessed the postoperative wound conditions after total knee arthroplasty (TKA). This study aimed to investigate whether skin closure using barbed sutures improves postoperative cosmetic outcomes compared to interrupted sutures and whether cosmetic outcomes correlate with knee-specific patient-reported outcome measures (PROMs) in TKA. This prospective, single-blind, randomized controlled trial assessed the cosmetic outcomes in patients who underwent TKA. The patients were randomly allocated to receive skin closure with barbed or interrupted sutures. There were 83 knees included in this study (44 in the barbed suture group and 39 in the interrupted group). The primary outcomes were cosmetic outcomes, assessed using the Patient Scar Assessment Scale (PSAS) from the Patient and Observer Scar Assessment Scale, and wound-related complications at 1 year postoperatively. The secondary outcomes were PROMs: Knee Society Score 2011 and Forgotten Joint Score-12. The relationship between cosmetic outcomes and PROMs was statistically analyzed. The PSAS total score was better in the barbed suture group than in the interrupted suture group (14.9 ± 7.7 versus 20.0 ± 13.7, P = 0.038). Wound complication rates did not differ between the two groups (0 [0 of 44] versus 5% [two of 39], P = 0.42). The PSAS total score was negatively correlated with the Knee Society Score 2011 symptoms (r = -0.39, P < 0.001), satisfaction (r = -0.26, P = 0.022), and expectation subsections (r = -0.37, P < 0.001), and the Forgotten Joint Score-12 total score (r = -0.25, P = 0.027). Skin closure using barbed sutures improved patient satisfaction with wound healing after TKA, and better cosmetic outcomes were associated with better postoperative PROMs. Selecting a suture technique that has a favorable effect on skin condition may contribute to improved patient satisfaction in TKA.