title: Barbed Suture Is Associated With Increased Risk of Wound Infection After Unicompartmental Knee Arthroplasty.
abstract: Literature addressing the risks of barbed suture in arthroplasty remains limited. No study to our knowledge has compared rates of wound infection between barbed and conventional suture after unicompartmental knee arthroplasty (UKA). We hypothesized that barbed suture would be associated with an increased risk of wound infection in patients undergoing UKA.
  
  
  
  Electronic records were retrieved for 1040 UKA procedures. Odds ratios with postoperative wound infection as the outcome and barbed suture as the exposure were calculated. Binary logistic regression corrected for age, gender, body mass index, operative time, and risk factors (smoking, diabetes, renal insufficiency, and immunosuppression). Barbed suture consisted of Quill #2 polydioxanone (or #0 Vicryl) for deep closure and Quill 2-0 Monoderm for subcuticular closure. Conventional suture consisted of #0 Vicryl for deep closure and subcuticular 2-0 Monocryl or staples for skin closure.
  
  
  
  A total of 839 procedures were included. Barbed suture was used in 333 surgeries, and conventional suture was used in 506. Eight cases of postoperative wound infection were identified. All infections occurred in the barbed suture cohort. Regression analysis revealed an association between subcuticular barbed suture and postoperative wound infection (odds ratio = 22.818, confidence interval = 2.69-2923.91; P = .0074).
  
  
  
  The findings indicate that the use of barbed suture in subcuticular layer closure is associated with an increased risk of wound infection. This may be exacerbated by early intensive mobilization, commonly undertaken after UKA to permit rapid functional return. We recommend against the use of barbed suture for subcuticular layer closure in UKA.
authors.affiliation: Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Harshvardhan
authors.initials: H
authors.lastname: Chawla
authors.affiliation: Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Jelle P
authors.initials: JP
authors.lastname: van der List
authors.affiliation: Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Fein
authors.affiliation: Division of Infectious Disease, Department of Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Henry
authors.affiliation: Computer Assisted Surgery Center, Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Pearle
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects*; D013997:Time Factors; D014945:Wound Healing
keywords: Quill; barbed suture; complications; dehiscence; infection; unicompartmental knee arthroplasty