Page 136 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F3.3 Clinical Safety and Quality Service I 14:30 Room 421

Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomised Controlled

Trial
Chan WKV 1, Chan PK 1, Chiu KY 1, 2, Yan CH 1, 2, Ng FY 1
1Department of Orthopaedics and Traumatology, Queen Mary Hospital,
2Department of Orthopaedics and Traumatology, Faculty of Medicine, The University of Hong Kong, Hong Kong

Tuesday, 3 May Introduction

Due to aging population, knee osteoarthritis is a major cause of morbidity in elderlies. Despite allocating more resources
to total knee arthroplasty (TKA), waiting time has not been shortened. This is because the demand is also rising rapidly.
Therefore, it is important to improve the efficiency of TKA. Wound closure is critical in TKA. Traditionally, arthrotomy
closure is time-consuming with multiple knots. Recently-introduced barbed suture allows more efficient wound closure with
continuous knotless suturing. Barbed suture can distribute tension more evenly, eliminate multiple bulky knots, which can
potentially reduce wound complication and hasten rehabilitation.

Objectives

Primary aim is to compare efficiency of barbed and traditional sutures in terms of wound closure time and cost. Secondary
aim is to compare any differences in wound complications, wound cosmesis and clinical outcome after TKA (Knee Society
Score (KSS) and knee movement range (ROM)).

Methodology

This is a single-centre, patient and assessor blinded, randomised controlled study approved by our Institutional Review
Board. Inclusion criterion includes valid informed consent, knee osteoarthritis scheduled for primary TKA. Exclusion
criterion includes underlying dermatological diseases and refuse to consent. Patients were randomised to either barbed
or traditional group. All TKAs were performed by the same surgical team with standardised technique. All pre- and post-
operative care were also standardised. For traditional group, interrupted and continuous sutures were used for arthrotomy
and subcutaneous closure respectively. For barbed group, continuous knotless suturing with bidirectional barbed suture was
used for both arthrotomy and subcutaneous closure. Arthrotomy and subcutaneous closure time was recorded. Leak test
was performed for water-tight closure of arthrotomy. Patients were followed up at two weeks, six weeks and three months.

Results

109 TKAs (55 barbed; 54 traditional) were included for analysis. Both arthrotomy and subcutaneous closure time were
significantly shorter in barbed group (arthrotomy 325 seconds versus 491 seconds (p <0.01); subcutaneous 306 seconds
versus 381 seconds (p <0.01)). Significantly more positive Leak test (arthrotomy leakage) in traditional group ( 10 versus 2
(p<0.02). Total wound complication were significantly more in traditional group (11 versus 2 (p<0.03)). Wound cosmetic rating,
ROM and KSS were comparable at follow-ups (p >0.05). In

Conclusion

Barbed suture can improve efficiency of TKA through shortening operation time and reducing wound complications.

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