CORR Insights^®: Is There an Advantage to Knotless Barbed Suture in TKA Wound Closure? A Randomized Trial in Simultaneous Bilateral TKAs

Excerpt

The use of barbed sutures in TKA remains a controversial topic. Previously published studies have found faster closure times, stronger repairs, and a more complete seal of the tissue layers [2‐4, 6]. However, another study [1] found local wound complications to be more common when barbed sutures were added to a standard closure. Additionally, barbed sutures are more expensive, and the purported time saved in the operating room often does not translate into real healthcare dollars, despite the fact the current study [5] has shown a minute-to-dollars savings. The correlation between operative time reduction and cost is debatable. A single minute of time in the operating room often does not directly cost or save money. Many institutions and anesthesia teams bill on an hourly rate. Therefore, if the additive time saved per case does not exceed an hour, or allow an additional procedure to be performed in that room, then there likely is no true savings being realized by the hospital or healthcare system. The studies that have shown decreased closure times have previously reported that this operating room time reduction (translated as minutes-to-dollars saved based on calculated costs at their institutions) appears to offset the material costs [2‐4, 6]. Although improved cosmesis and faster wound closures are appealing potential characteristics of barbed sutures, this must come with the same safety profiles and comparable complication rates to standard suture materials. Currently, barbed sutures are available in unidirectional and bidirectional patterns, which may have implications in speed of closure and local wound complications. Each of these offerings calls for detailed studies to determine safety and efficacy profiles. …