title: Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA.
abstract: BACKGROUND
  The use of barbed suture for surgical closure has been associated with lower operative times, equivalent wound complication rate, and comparable cosmesis scores in the plastic surgery literature. Similar studies would help determine whether this technology is associated with low complication rates and reduced operating times for orthopaedic closures.
  
  
  OBJECTIVE
  We compared a running barbed suture with an interrupted standard suture technique for layered closure in primary TKA to determine if the barbed suture would be associated with (1) shorter estimated closure times; (2) lower cost; and (3) similar closure-related perioperative complication rates.
  
  
  METHODS
  We retrospectively compared two-layered closure techniques in primary TKA with either barbed or knotted sutures. The barbed group consisted of 104 primary TKAs closed with running barbed suture. The standard group consisted of 87 primary TKAs closed with interrupted suture. Cost analysis was based on cost of suture and operating room time. Clinical records were assessed for closure-related complications within the 6-week perioperative period.
  
  
  RESULTS
  Average estimated closure time was 2.3 minutes shorter with the use of barbed suture. The total closure cost was similar between the groups. The closure-related perioperative complication rates were similar between the groups.
  
  
  CONCLUSIONS
  Barbed suture is associated with a slightly shorter estimated closure time, although this small difference is of questionable clinical importance. With similar overall cost and no difference in perioperative complications in primary TKA, this closure methodology has led to more widespread use at our institution.
authors.affiliation: Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Gililland
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Anderson
authors.forename: Grant
authors.initials: G
authors.lastname: Sun
authors.forename: Jill A
authors.initials: JA
authors.lastname: Erickson
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects / Q000191:economics*; D013537:Sutures / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology