title: A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples.
abstract: OBJECTIVE
  Nylon sutures and skin staples are used commonly in total knee arthroplasty (TKA) surgical wound closure. However, there is no study that compares the wound healing efficacy and patient satisfaction scores of both techniques in the same knee.
  
  
  METHODS
  We randomised 70 patients who underwent primary TKA into two groups. In one group of 34 patients, the skin at the upper half of the wound was closed with skin staples and the lower half of the wound was closed with simple interrupted nylon sutures. In the other group of 36 patients, the skin at the upper half of the wound was closed with nylon stitches and the lower half of the wound was closed with skin staples. We recorded the wound closure time, pain score at the time of stitch removal, wound complication rate, patient satisfaction score, and the Hollander wound evaluation score at the post-operative periods of five days, 14 days, six weeks, three months, and six months. Each half wound was analysed separately.
  
  
  RESULTS
  The mean patient body mass index was 26.8 kg/m(2) (standard deviation 6.3). A total of 70 nylon stitched wounds and 70 skin stapled wounds were analysed. There were no significant differences in wound complication rates, patient satisfaction score, and the Hollander wound evaluation score between both types of wounds (p > 0.05). The wound closure time for skin stapled wounds was significantly lower than the nylon stitched wounds (p < 0.001). However, the skin stapled wounds had a significantly higher pain score at the time of stitch removal (p < 0.001).
  
  
  CONCLUSIONS
  Skin staples and nylon stitches had comparable results with respect to wound healing and patient satisfaction in TKA wound closure in non-obese patients. The benefit of skin staples over nylon stitches was a decrease in operative time, but was more painful upon removal.Cite this article: V. Yuenyongviwat. A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples. Bone Joint Res 2016;5:185-190. DOI: 10.1302/2046-3758.55.2000629.
authors.affiliation: Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand varahortho@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Yuenyongviwat
authors.affiliation: Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Iamthanaporn
authors.affiliation: Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand.
authors.forename: T
authors.initials: T
authors.lastname: Hongnaparak
authors.affiliation: Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand.
authors.forename: B
authors.initials: B
authors.lastname: Tangtrakulwanich
keywords: Nylon stitches; Skin staple; Total knee arthroplasty; Wound closure