The efficacy and safety of knotless barbed sutures in total joint arthroplasty: a meta-analysis of randomized-controlled trials.

BACKGROUND: The knotless barbed sutures (KBS) are an innovative type of suture that can accelerate the placement of sutures and eliminate knot tying. Whether the KBS are safe and efficient in total joint arthroplasty (TJA) remains controversial. Therefore, we conducted a meta-analysis to evaluate its efficacy and safety. METHODS: Randomized-controlled trials (RCTs) were identified from the PubMed, Embase, and Cochrane Library databases up to October 2017. The Cochrane risk of bias tool was used to assess methodological quality. The statistical analysis was performed with RevMan 5.3.5 software. RESULTS: A total of five RCTs (600 participants) were included in our meta-analysis. The results showed that KBS reduced wound suture time (MD - 4.51, 95% CI - 5.37 to - 3.66, P < 0.00001) and the wound suture cost (MD - 282.63, 95% CI - 445.32 to - 119.95, P < 0.00001), and did not significantly increase the rate of complications (OR 0.77, 95% CI 0.42-1.39, P = 0.13) or intraoperative events (OR 0.86, 95% CI 0.04-17.28, P = 0.92). There were no significant differences in ROM at postoperative 6 weeks and 3 months (MD - 0.74, 95% CI - 4.19 to 2.71, P = 0.67; MD - 0.30, 95% CI - 2.62 to 2.02, P = 0.80; respectively). CONCLUSION: Our findings suggest that KBS are a safe and effective method for TJA. Given the possible biases, adequately powered and better designed studies with longer follow-up are required to reach a firmer conclusion.

[Bidirectional knotless barbed sutures during primary total knee arthroplasty: effective solution or new problem?] / Primenenie dvunapravlennykh nitei s nasechkami dlia nepreryvnogo bezuzlovogo shva v pervichnoi artroplastike kolennogo sustava.

THE HYPOTHESIS OF THE STUDY: The use of bidirectional knotless barbed sutures for closure of capsule and subcutaneous fat tissue in primary total knee arthroplasty (TKA) is safe and time-saving. MATERIAL AND METHODS: 302 patients with end-stage osteoarthritis scheduled for primary non-complex TKA were randomly divided into two prospective groups: in group I (N=102) the capsule of the knee joint and subcutaneous fat tissues were closed by continuous braided suture while in group II (N=200) by bidirectional knotless barbed sutures. The skin in both groups was closed by non-absorbable monofilament polycaproamide uninterrupted suture. RESULTS: The time of the surgery was significantly shorter in group II (65,25±11,9 min) than in group I (72,5±14,7 min) (p<0.05). The volume of hidden blood loss was similar in both groups. The number of patients with superficial infection during the first two week after surgery did not differ significantly (1,9% (I) and 1% (II)): they all healed successfully after skin debridement and additional closure. There were no cases of deep periprosthetic infection (PPI). At 3-month follow-up no difference found regarding pain level and knee function (Knee Society Score). CONCLUSION: The use of bidirectional knotless barbed sutures in TKA reduces the time of surgery, does not affect the volume of hidden blood loss or PPI occurrence.

A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture.

PURPOSE: To determine repair site bulk, gliding resistance, work of flexion, and 1-mm gap formation force in zone II flexor tendon lacerations repaired with knotless barbed or traditional braided suture. METHODS: Transverse zone II lacerations of the flexor digitorum profundus (FDP) tendon were created in 36 digits from 6 matched human cadaveric pairs. Repair was performed with 2-0 barbed suture (n = 18) or 3-0 polyethylene braided suture (n = 18). Pre- and postrepair cross-sectional area was measured followed by quantification of gliding resistance and work of flexion during cyclic flexion-extension loading at 10 mm/min. Thereafter, the repaired tendons were loaded to failure. The force at 1 mm of gap formation was recorded. RESULTS: Repaired FDP tendon cross-sectional area increased significantly from intact, with no difference noted between suture types. Gliding resistance and work of flexion were significantly higher for both suture repairs; however, we identified no significant differences in either nondestructive biomechanical parameters between repair types. Average 1-mm gap formation force with the knotless barbed suture (52 N) was greater than that of the traditional braided suture (43 N). CONCLUSIONS: We identified no significant advantage in using knotless barbed suture for zone II FDP repair in our primary, nondestructive mechanical outcomes in this in vitro study. CLINICAL RELEVANCE: In vivo studies may be warranted to determine if one suture method has an advantage with respect to the parameters tested at 4, 6, and 12 plus weeks postrepair and the degree of adhesion formation. The combined laboratory and clinical data, in additional to cost considerations, may better define the role of barbed knotless suture for zone II flexor tendon repair.

Duet laparoscopic repair with knotless barbed sutures for treatment of perforated peptic ulcer: reality in general surgery with lacking of manpower.

BACKGROUND: Perforated peptic ulcer (PPU) is a fatal complication of peptic ulcer disease, which requires emergency surgery. Laparoscopic repair is the widely accepted and effective method for the treatment of PPU. The aim of this study was to evaluate the safety and efficacy of duet laparoscopic repair of PPU with knotless barbed sutures. METHODS: From January 2013 to May 2019, 40 patients with PPU underwent laparoscopic primary repair and omentopexy at the Dankook University Hospital. The operative outcomes and complications of patients undergoing surgery using continuous suturing with absorbable knotless barbed sutures (group A, n=15) were compared with those undergoing surgery with conventional interrupted sutures (group B, n=25). RESULTS: The mean operative time was significantly shorter in group A than group B (84.4±39.8 vs. 104.2±49.4 min, P<0.001). There were no differences in other operative outcomes or postoperative complications (group A vs. group B, 20.0% vs. 24.0%, respectively; P=0.249) between the two groups. The mean operation time spent for laparoscopic sutures and omentopexy was 22.7 minutes. CONCLUSIONS: The findings of the current study, albeit performed retrospectively at a single institution, suggested that duet laparoscopic repair of PPU with knotless barbed sutures might be considered as an alternative option, especially in hospitals lacking manpower.

A Novel Knotless Barbed Suture Technique for Traumatic Thoracolumbar Fracture in Posterior Surgery.

BACKGROUND: Surgical wound closure directly influences spinal surgical efficiency and several postoperative complications. The traditional suture technique is time-consuming and associated with greater rates of complications. Bidirectional absorbable barbed sutures seem to compensate for some of the limitations of traditional suture; however, they rarely are reported in spinal surgery. We designed a novel suture technique for use in thoracolumbar spinal surgery. METHODS: The data of 189 patients with traumatic thoracolumbar fractures were analyzed between bidirectional barbed suture closure and traditional interrupted suture closure. Data of operative time, wound closure time, length of incision, intraoperative blood loss, complications of wound dehiscence and postoperative hematoma, cost, and neurologic status were collected. RESULTS: No significant differences were observed in the baseline demographics of included patients. Compared with the traditional suturing group, the barbed sutures decreased the mean operative time (P = 0.037), suture time (P < 0.01), and mean suturing time (P < 0.01) significantly, although no statistically significant differences were found in blood loss (P = 0.724) and neurologic functional scores (preoperative: P = 0.901; 3 months after surgery: P = 0.208; final follow-up assessments: P = 0.163), and no statistically significant differences were found in rates of postoperative infection, hematoma, and wound dehiscence. CONCLUSIONS: Our findings suggest that the novel knotless barbed suture has comparable strength to traditional sutures, with the advantage of less suturing time. It is an efficient, safe technique, and alternative choice for patients with thoracolumbar fracture after posterior surgery.