Comparative study on effectiveness of intermittent suture versus cosmetic suture in total knee arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Shuiqing , CHEN Liang , ZENG Min , XIE Jie ,  HU Yihe

Department of Orthopedics, Xiangya Hospital Central South University, Changsha Hunan, 410000, P.R.China;

Corresponding?author：

HU Yihe, Email: xy_huyh@163.com

Keywords：

Total knee arthroplasty; incision suture; intermittent suture; cosmetic suture; periprosthetic joint infection

DOI：

10.7507/1002-1892.201811066

Video：

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Objective To compare the effectiveness of the intermittent suture and the cosmetic suture in total knee arthroplasty (TKA). Methods A clinical data of 48 patients with knee osteoarthritis, who underwent initial TKA between January 2017 and April 2018, was retrospectively analyzed. Among them, 23 patients underwent intermittent suture (group A) and 25 patients underwent cosmetic suture (group B). There was no significant difference in gender, age, body mass index, disease duration, degrees of varus and valgus deformities, knee society score (KSS), visual analogue scale (VAS) score, and levels of interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) in serum before operation between the two groups (P>0.05). KSS scores at 1 and 6 months after operation were used to assess the knee function. VAS scores at 1, 3, and 5 days after operation were used to assess the pain degree of knee. Levels of IL-6, PCT, CRP, and ESR in serum at 1 day and 1 month after operation were recorded to evaluate the risk of periprosthetic infection. Likert score at 6 months after operation was used to evaluate the satisfaction of incision. The hospitalization time after operation was also recorded. Results All patients were followed up 7- 17 months (mean, 11.3 months). There was no significant difference in hospitalization time after operation between two groups (t=?1.907, P=0.063). The Likert score in group A was significantly lower than that in group B (t=?2.196, P=0.033). The VAS score, KSS clinical score and KSS functional score at different time points after operation were significantly better than those before operation in two groups (P<0.05). The VAS score at 5 days after operation was better than that at 1 day after operation in two groups, and the KSS clinical score and KSS functional score at 6 months after operation were better than those at 1 month after operation in two groups, all showing significant differences (P<0.05). The VAS scores at 3 and 5 days after operation were significantly lower in group B than in group A (P<0.05), and there was no significant difference in VAS score and KSS scores between two groups at other time points after operation (P>0.05). There was no significant difference in the levels of IL-6, PCT, CRP, and ESR between the two groups at different time points after operation (P>0.05). Conclusion Cosmetic suture is superior to intermittent suture in incision appearance and pain management, but there is no significant difference in short-term joint function and risk of periprosthetic infection after TKA.

Citation： HU Shuiqing, CHEN Liang, ZENG Min, XIE Jie, HU Yihe. Comparative study on effectiveness of intermittent suture versus cosmetic suture in total knee arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1121-1126. doi: 10.7507/1002-1892.201811066 Copy

1.	郭保逢, 秦泗河, 黃野. 膝關節骨關節炎的保膝治療進展. 中國修復重建外科雜志, 2018, 32(10): 1292-1296.
2.	張星火, A. T. Wild, 于振山, 等非置換髕骨的非骨水泥型全膝關節置換術中期療效. 中國修復重建外科雜志, 2008, 22(6): 669-672.
3.	黃小敬, 楊勝武, 袁健東. 髖膝關節置換術后假體周圍感染的危險因素分析. 中華醫院感染學雜志, 2014, 24(6): 1471-1473.
4.	彭開勤. 切口愈合的影響因素. 臨床外科雜志, 2007, 15(9): 588-589.
5.	Sah AP. Is there an advantage to knotless barbed suture in TKA wound closure? A randomized trial in simultaneous bilateral TKAs. Clin Orthop Relat Res, 2015, 473(6): 2019-2027.
6.	Newman JT, Morgan SJ, Resende GV, et al. Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients. Patient Saf Surg, 2011, 5(1): 26.
7.	Smith EL, DiSegna ST, Shukla PY, et al. Barbed versus traditional sutures: closure time, cost, and wound related outcomes in total joint arthroplasty. J Arthroplasty, 2014, 29(2): 283-287.
8.	Maheshwari AV, Naziri Q, Wong A, et al. Barbed sutures in total knee arthroplasty: are these safe, efficacious, and cost-effective? J Knee Surg, 2015, 28(2): 151-156.
9.	韋健, 洪定鋼. 膝關節置換術患者不同縫合方式對傷口愈合影響的研究. 中國骨與關節雜志, 2016, 5(12): 900-903.
10.	Songu M, Aslan H, Denizoglu I, et al. Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results. Acta Otolaryngol, 2013, 133(11): 1201-1206.
11.	王亞飛, 李紅喜, 廉永云, 等. 運動體位下間斷縫合在人工全膝關節置換術中的應用研究. 中國修復重建外科雜志, 2018, 32(4): 400-405.
12.	呂增亮, 葛武. 髖膝關節置換術后假體周圍感染的危險因素分析. 中國臨床研究, 2015, 28(11): 1496-1497.
13.	Boddapati V, Fu MC, Mayman DJ, et al. Revision total knee arthroplasty for periprosthetic joint infection is associated with increased postoperative morbidity and mortality relative to noninfectious revisions. J Arthroplasty, 2018, 33(2): 521-526.
14.	Ro DH, Kim JK, Kim S, et al. Periprosthetic joint infection does not preclude good outcomes after a revision total knee arthroplasty: a 7-year follow-up study of 144 retrospective cases. Biomed Res Int, 2018, 2018: 2582140.
15.	Monticone M, Ferrante S, Rocca B, et al. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(2): 231-239.
16.	李玉龍, 翁習生, 董玉雷. 老年全膝關節置換術圍手術期并發癥影響因素的研究進展. 中華老年骨科與康復電子雜志, 2016, 2(3): 177-180.
17.	曹光磊, 沈惠良, 安帥, 等. 高齡患者人工全膝關節置換術的并發癥及療效分析. 中華關節外科雜志(電子版), 2015, (1): 50-54.
18.	孫鐵莉. 婦科腹部皮膚縱切口縫線選擇的探討. 中國實用醫藥, 2015, 10(26): 85-86.
19.	郭彩霞. 使用 2-0 可吸收線會陰切口皮下美容縫合與傳統絲線縫合對產婦康復的影響. 實用婦科內分泌電子雜志, 2015, 2(5): 51-52.
20.	伍明. 可吸收線（快薇喬 4/0）連續縫合家兔頭皮與普通慕絲線（4/0）間斷縫合的優劣對照研究. 長沙: 中南大學, 2007.
21.	Amend B, Muller O, Bedke J, et al. Biomechanical proof of barbed sutures for the efficacy of laparoscopic pyeloplasty. J Endourol, 2012, 26(5): 540-544.
22.	Nett M, Avelar R, Sheehan M, et al. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. J Knee Surg, 2011, 24(1): 55-59.
23.	程飚, 付小兵, 盛志勇. 免疫因素在瘢痕形成和發展中的作用. 中國臨床康復, 2002, 6(4): 472-473, 486.
24.	Yuan K, Li WD, Qiang Y, et al. Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty. Surg Infect (Larchmt), 2015, 16(2): 146-150.
25.	黃強開, 杜少華, 衛小春, 等. 白介素-6 對于早期診斷關節置換術后假體周圍感染的意義. 中華關節外科雜志(電子版), 2012, 6(3): 74-76.
26.	郭旗, 鄭稼, 金毅, 等. 血沉、C 反應蛋白及 ECT 聯合診斷假體周圍感染臨床研究. 中華實用診斷與治療雜志, 2010, 24(3): 255-257.
27.	Bouaicha S, Blatter S, Moor BK, et al. Early serum procalcitonin level after primary total hip replacement. Mediators Inflamm, 2013, 2013: 927636.

1. 郭保逢, 秦泗河, 黃野. 膝關節骨關節炎的保膝治療進展. 中國修復重建外科雜志, 2018, 32(10): 1292-1296.
2. 張星火, A. T. Wild, 于振山, 等非置換髕骨的非骨水泥型全膝關節置換術中期療效. 中國修復重建外科雜志, 2008, 22(6): 669-672.
3. 黃小敬, 楊勝武, 袁健東. 髖膝關節置換術后假體周圍感染的危險因素分析. 中華醫院感染學雜志, 2014, 24(6): 1471-1473.
4. 彭開勤. 切口愈合的影響因素. 臨床外科雜志, 2007, 15(9): 588-589.
5. Sah AP. Is there an advantage to knotless barbed suture in TKA wound closure? A randomized trial in simultaneous bilateral TKAs. Clin Orthop Relat Res, 2015, 473(6): 2019-2027.
6. Newman JT, Morgan SJ, Resende GV, et al. Modality of wound closure after total knee replacement: are staples as safe as sutures? A retrospective study of 181 patients. Patient Saf Surg, 2011, 5(1): 26.
7. Smith EL, DiSegna ST, Shukla PY, et al. Barbed versus traditional sutures: closure time, cost, and wound related outcomes in total joint arthroplasty. J Arthroplasty, 2014, 29(2): 283-287.
8. Maheshwari AV, Naziri Q, Wong A, et al. Barbed sutures in total knee arthroplasty: are these safe, efficacious, and cost-effective? J Knee Surg, 2015, 28(2): 151-156.
9. 韋健, 洪定鋼. 膝關節置換術患者不同縫合方式對傷口愈合影響的研究. 中國骨與關節雜志, 2016, 5(12): 900-903.
10. Songu M, Aslan H, Denizoglu I, et al. Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results. Acta Otolaryngol, 2013, 133(11): 1201-1206.
11. 王亞飛, 李紅喜, 廉永云, 等. 運動體位下間斷縫合在人工全膝關節置換術中的應用研究. 中國修復重建外科雜志, 2018, 32(4): 400-405.
12. 呂增亮, 葛武. 髖膝關節置換術后假體周圍感染的危險因素分析. 中國臨床研究, 2015, 28(11): 1496-1497.
13. Boddapati V, Fu MC, Mayman DJ, et al. Revision total knee arthroplasty for periprosthetic joint infection is associated with increased postoperative morbidity and mortality relative to noninfectious revisions. J Arthroplasty, 2018, 33(2): 521-526.
14. Ro DH, Kim JK, Kim S, et al. Periprosthetic joint infection does not preclude good outcomes after a revision total knee arthroplasty: a 7-year follow-up study of 144 retrospective cases. Biomed Res Int, 2018, 2018: 2582140.
15. Monticone M, Ferrante S, Rocca B, et al. Home-based functional exercises aimed at managing kinesiophobia contribute to improving disability and quality of life of patients undergoing total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil, 2013, 94(2): 231-239.
16. 李玉龍, 翁習生, 董玉雷. 老年全膝關節置換術圍手術期并發癥影響因素的研究進展. 中華老年骨科與康復電子雜志, 2016, 2(3): 177-180.
17. 曹光磊, 沈惠良, 安帥, 等. 高齡患者人工全膝關節置換術的并發癥及療效分析. 中華關節外科雜志(電子版), 2015, (1): 50-54.
18. 孫鐵莉. 婦科腹部皮膚縱切口縫線選擇的探討. 中國實用醫藥, 2015, 10(26): 85-86.
19. 郭彩霞. 使用 2-0 可吸收線會陰切口皮下美容縫合與傳統絲線縫合對產婦康復的影響. 實用婦科內分泌電子雜志, 2015, 2(5): 51-52.
20. 伍明. 可吸收線（快薇喬 4/0）連續縫合家兔頭皮與普通慕絲線（4/0）間斷縫合的優劣對照研究. 長沙: 中南大學, 2007.
21. Amend B, Muller O, Bedke J, et al. Biomechanical proof of barbed sutures for the efficacy of laparoscopic pyeloplasty. J Endourol, 2012, 26(5): 540-544.
22. Nett M, Avelar R, Sheehan M, et al. Water-tight knee arthrotomy closure: comparison of a novel single bidirectional barbed self-retaining running suture versus conventional interrupted sutures. J Knee Surg, 2011, 24(1): 55-59.
23. 程飚, 付小兵, 盛志勇. 免疫因素在瘢痕形成和發展中的作用. 中國臨床康復, 2002, 6(4): 472-473, 486.
24. Yuan K, Li WD, Qiang Y, et al. Comparison of procalcitonin and C-reactive protein for the diagnosis of periprosthetic joint infection before revision total hip arthroplasty. Surg Infect (Larchmt), 2015, 16(2): 146-150.
25. 黃強開, 杜少華, 衛小春, 等. 白介素-6 對于早期診斷關節置換術后假體周圍感染的意義. 中華關節外科雜志(電子版), 2012, 6(3): 74-76.
26. 郭旗, 鄭稼, 金毅, 等. 血沉、C 反應蛋白及 ECT 聯合診斷假體周圍感染臨床研究. 中華實用診斷與治療雜志, 2010, 24(3): 255-257.
27. Bouaicha S, Blatter S, Moor BK, et al. Early serum procalcitonin level after primary total hip replacement. Mediators Inflamm, 2013, 2013: 927636.

Chinese Journal of Reparative and Reconstructive Surgery

Comparative study on effectiveness of intermittent suture versus cosmetic suture in total knee arthroplasty

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