Background: Wound closure in total knee arthroplasty (TKA) is an essential part of the procedure that affects the outcome of the surgery. Traditionally, closure of capsular and subcutaneous layer is performed using absorbable sutures placed in an interrupted manner. Skin closure usually used non-absorbable sutures placed in an interrupted fashion. A bidirectional, barbed suture that is self-anchoring and that does not require to tie knots during closure have recently begun to gain more popularity.

Objective: To evaluate the efficacy of barbed suture for closure of wound in TKA as compared with traditional suture. The main outcome measures were wound-related complications, wound closure time, Knee Society Score (KSS), and cost.

Materials and Methods: The authors recruited 60 patients planned to undergo TKA. Patients were randomly divided in two groups, group 1 (conventional group; 30 patients) and group 2 (barbed group; 30 patients). In the conventional group, the capsular closure and subcutaneous closure were performed in an interrupted fashion using size 1 and size 2-0 vicryl. Skin closure was performed in running subcuticular suture using size 4-0 vicryl. In the barbed group, the capsular closure, subcutaneous closure, and skin closure were performed in running manner using size 2, size 0, and size 2-0 barbed suture. Patient demographics, preoperative KSS, and operative data were record. All patients were seen for follow-up at two and six weeks and three months postoperatively.

Results: Wound-related complications were similar in both groups. Significant shorter wound closure time in barbed group (12.35 minutes versus 24.45 minutes, p<0.001). Both groups demonstrated improvement in KSS after surgery, but no significant difference was found between the two groups. The average cost of barbed sutures was found to be 2,420 baht more than the conventional sutures per arthroplasty (3,300 baht versus 880 baht, p<0.001).

Conclusion: Use of barbed suture for closure of surgical wounds in TKA leads to satisfied outcomes without adverse effect to wound security and healing process. Wound-related complications were comparable to conventional sutures. Use of barbed suture was associated with shorten wound closure time. The average cost of barbed sutures was found to be more expensive than the conventional sutures.

Keywords: Barbed suture, Quill™, Closure, Total knee arthroplasty