title: Barbed versus standard sutures in total knee arthroplasty: a meta-analysis.
abstract: BACKGROUND
  The use of barbed sutures in various surgical specialities has shown lower operative time and equivalent wound complications. Use of barbed suture in total knee arthroplasty is still at nascent stage with only few studies comparing it with the standard closure techniques. The purpose of this review was to appraise the clinical outcomes of barbed suture use in closure of total knee arthroplasty.
  
  
  METHODS
  We searched the Cochrane library, PubMed and EMBASE up to December 2014 for clinical trials comparing the outcomes of closure of total knee arthroplasty with barbed sutures versus standard sutures. When there was no high heterogeneity, we used a fixed effects model. Dichotomous variables were presented as risk ratios (RRs) with 95 % confidence intervals (CIs), and continuous data were measured as measured differences with 95 % CIs.
  
  
  RESULTS
  Five studies were included, with sample size ranging from 178 to 416. Fixed effect analysis showed that superficial infection was higher with barbed suture (RR 1.54, 95 % CI 0.36-2.59, P = 0.94). The barbed sutures have significantly lower closure time (MI -2.74, CI -3.06, -2.42, P < 0.00001). There was no difference in terms of deep infection, wound dehiscence, arthrofibrosis and total operative time.
  
  
  CONCLUSIONS
  Our meta-analysis showed that the use of barbed sutures was associated with increased superficial infection rate and shorter estimated closure time. More RCTs are needed to examine the efficacy and safety of the barbed sutures.
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India, sanjaymeena@hotmail.com.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Meena
authors.forename: Shreesh
authors.initials: S
authors.lastname: Gangary
authors.forename: Pankaj
authors.initials: P
authors.lastname: Sharma
authors.forename: Buddhadev
authors.initials: B
authors.lastname: Chowdhury
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005355:Fibrosis / Q000209:etiology; D006801:Humans; D007719:Knee Joint / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome