title: Barbed sutures in total hip and knee arthroplasty: what is the evidence? A meta-analysis.
abstract: BACKGROUND
  Newer methods of wound closure such as bidirectional barbed sutures hold the potential to reduce closure time and thus overall operating room costs during total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, it is unclear whether these sutures have similar clinical outcomes or whether they place the patient at risk of developing wound complications that may outweigh the time-saving benefits of these sutures.
  
  
  METHODS
  A systematic review of the literature was performed to identify all level I trials that reported the use of barbed suture during TJA. We analyzed the efficacy, safety, major and minor complications, and overall cost related to barbed sutures.
  
  
  RESULTS
  Four studies met our criteria, and included 588 patients who were randomized either to barbed suture closure (n = 290 TJAs, 268 TKAs, and 22 THAs) or to a matched conventional suture cohort (n = 298 TJAs, 279 TKAs, and 19 THA). In terms of time savings with wound closure, the barbed suture was 6.3 minutes faster than the conventional cohort (p < 0.05). The odds for developing a minor complication were nearly identical (odds ratio [OR] 1.04, p = 0.95) and for major complication was not significantly different (OR 2.94, p = 0.27). The overall mean savings including both THA and TKA was USD 298 per case.
  
  
  CONCLUSIONS
  In randomized controlled trials, barbed sutures are consistently associated with shorter wound closure time, which also corresponds to cost savings, even when the higher cost of these sutures is taken into account. There was no significant difference in the odds of experiencing either minor or major complications between patients in whom barbed sutures versus standard sutures were used for wound closure. Current evidence supports continued use of these sutures.
  
  
  METHODS
  Level I.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA. borziorw@gmail.com.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Borzio
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA. robertpivec@yahoo.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Pivec
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA. bhaveen.k@gmail.com.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA. juljau@gmail.com.
authors.forename: Julio J
authors.identifier: http://orcid.org/0000-0002-7878-0241
authors.initials: JJ
authors.lastname: Jauregui
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA. adityavikramm@gmail.com.
authors.forename: Aditya V
authors.initials: AV
authors.lastname: Maheshwari
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome
keywords: Barbed sutures; Meta analysis; Total hip arthroplasty; Total knee arthroplasty; Wound closure