Elsevier

The Journal of Arthroplasty

Volume 27, Issue 7, August 2012, Pages 1413.e1-1413.e4
The Journal of Arthroplasty

Case Report
Extensor Mechanism Repair Failure With Use of Bidirectional Barbed Suture in Total Knee Arthroplasty

https://doi.org/10.1016/j.arth.2011.08.013Get rights and content

Abstract

Total knee arthroplasty (TKA) continues to advance as innovative devices become available. #2 PDO Quill SRS (Angiotech, Reading, Pa) bidirectional barbed suture was used for 161 primary TKAs at our facility. We report on 3 separate cases of extensor mechanism repair failure after primary TKA in which a barbed suture was used for extensor mechanism closure. Before the implementation of this device, there were no reported failures in 385 primary TKAs. We recommend that surgeons who use this device for extensor mechanism repair of a medial parapatellar arthrotomy in TKA exercise caution when operating on patients with morbid obesity, diabetes, and rheumatoid arthritis. We have discontinued use of the bidirectional barbed suture until more definitive large orthopedic studies establish its efficacy and safety.

Section snippets

Case 1

A 56-year-old woman with severe osteoarthritis of the right knee elected to proceed with a TKA after failing conservative measures. Preoperatively, the patient had bilateral varus deformity of the knees with a 5° flexion contracture and flexion to 110°. She was 5 ft 3 in tall, weighed 294 lb, with a body mass index of 54.1 kg/m2, and her medical history included type II diabetes mellitus, obesity, and hypertension.

The TKA was performed through a standard medial parapatellar arthrotomy. The

Case 2

A 69-year-old man with severe osteoarthritis of the left knee elected to proceed with a TKA after failing conservative measures. Preoperatively, the patient had bilateral varus deformity of the knees with a 5° flexion contracture and flexion to 110°. He was 6 ft tall, weighed 325 lb, with a body mass index of 44.5 kg/m2, and his medical history included type II diabetes mellitus, hyperlipidemia, gout, and hypertension. The TKA was performed using the same technique as described in the

Case 3

A 71-year-old man with severe osteoarthritis of the right knee elected to proceed with a TKA after failing conservative measures. Preoperatively, the patient had bilateral varus deformity of the knees with a 10° flexion contracture and flexion to 95°. He was 5 ft 10 in tall, weighed 210 lb, with a body mass index of 32.95 kg/m2. He smoked half of a pack of cigarettes daily, and his medical history included hypertension and rheumatoid arthritis. The TKA was performed using the same technique as

Discussion

Extensor mechanism repair failure after primary TKA is a rare complication. In our previous 385 primary knee arthroplasties using interrupted sutures for extensor mechanism repair, there have been no extensor mechanism repair ruptures to our knowledge. Although we were early adopters of this new application of an existing technology, we have now stopped use until more definitive orthopedic studies become available. Widespread adoption of the bidirectional barbed suture in arthroplasty surgery

References (8)

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    Our results also showed uneventful wound healing response without the incidence of wound complications, such as surgical site infections and reoperation, in both groups during the 6-month follow-up period. These findings were comparable to the previous studies,12,13 which implied that either the CLS or IHM techniques with traditional braided suture materials are safe. Moreover, the previous studies demonstrated that using barbed suture for superficial wound closure in TKR might be associated with higher risk for wound complications.11,24,25

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    Finally, it is not possible at this time to differentiate infectious mechanisms by the level of closure (eg, barbed suture in the deep vs subcuticular layer). Deep dehiscence was noted in 2 patients who received Quill #2 PDO during arthrotomy closure, coinciding with a case series by Wright et al [21] in which 3 extensor repairs using Quill PDO failed after TKA. As subgroup analysis revealed no difference in infection rates between cohorts 1A and 1B, the use of barbed suture for retinacular closure cannot be regarded as an independent risk factor at present.

  • Superficial wound closure complications with barbed sutures following knee arthroplasty

    2014, Journal of Arthroplasty
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    In analyzing our results, we noticed significantly more infections requiring antibiotics occurred in skin closed with barbed sutures than in skin closed with staples; this has initiated a change in practice at our institution. Our findings are supported by recent studies, as some of the literature indicates that barbed sutures may contribute to increased complications in wound healing: Wright et al report that in TKA closure, barbed sutures yielded an increased rate of extensor mechanism repair failure compared to standard sutures [30]. Assessment of barbed sutures in closing fascial and subcutaneous fat layers conducted in patients receiving body contouring surgery also revealed that barbed sutures led to wound healing complications [19].

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    Barbed sutures are becoming more popular in many areas of surgery because of ease and speed of placement. However, the literature concerning barbed sutures in the field of orthopaedics, particularly joint arthroplasty, is sparse and contains only retrospective cadaveric and observational studies [13–16,22]. The purpose of this study was to prospectively investigate barbed sutures by comparing them to traditional sutures in three domains; time to wound closure, cost, and rates of wound complications when used to close TKA's and THA's.

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The Conflict of Interest statement associated with this article can be found at doi:10.1016/j.arth.2011.08.013.

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