Use of a Barbed Suture in the Closure of Hip and Knee Arthroplasty Wounds

Wound closure in primary and revision total hip and knee arthroplasty is an essential and critical component of the procedure. A well-performed closure may take up to 20 to 30 minutes for primary and revision surgeries, respectively. Traditionally, a layered closure is performed using various forms of absorbable and nonabsorbable sutures placed in an interrupted fashion, requiring the surgeon to tie knots to secure each stitch. Disadvantages of knot tying include increased operative time, prominence in subcutaneous layers, and local tissue ischemia. Recently, a bi-directional, barbed suture has been introduced that affords surgeons the ability to close soft tissue layers in a running fashion without the need for knot tying. The bi-directional nature of the barbs allows for simultaneous closure from the wound center, therefore offsetting the increased cost per suture by the decreased number of sutures used and the time saved in the operating room to close the incision. Additional potential advantages of using knotless sutures include enhanced biomechanical strength, increased resistance to catastrophic arthrotomy failure, and a more watertight closure. Our early data support the efficiency and safety of using this suture in total joint arthroplasty wound closure. This article reviews our experience and describes the technique for using barbed sutures during wound closure in 940 cases of primary and revision total joint arthroplasties.