The Effect of Absorbable Knotless Barbed Suture on Total Knee Arthroplasty Incision Closure: A Retrospective Cohort Study

Background Numerous studies have investigated the utilization of absorbable knotless barbed sutures in total knee arthroplasty (TKA) and compared various techniques and materials; however, the efficacy of full-thickness closure remains inconsistent. This retrospective study aimed to evaluate whether full-thickness wound closure in TKA using absorbable knotless barbed sutures, compared with running-coated Vicryl Plus antibacterial sutures, was associated with a reduction in complication rates. Methods Patients who underwent primary unilateral TKA with incision closure using either absorbable knotless barbed sutures or coated Vicryl Plus antibacterial sutures between January 2020 and September 2023 were retrospectively enrolled. Demographics, comorbidities, perioperative data, postoperative complications, Knee Society Scores (KSS), knee range of motion (ROM), and scar appearance were systematically collected and analyzed over a 24-month follow-up. Perioperative risk factors associated with superficial wound infection were also evaluated. Results At the 24-month postoperative follow-up, no statistically significant differences were observed in major complication rates among the four groups ( P  > 0.05), including periprosthetic joint infection ( P  > 0.05) and revision surgery ( P  > 0.05). However, a statistically significant difference was observed in the overall incidence of minor superficial wound complications among the groups ( P  < 0.01). Although no significant differences were found in superficial wound infection, effusion, or wound dehiscence between the groups (all P  > 0.05), Groups A, B, and C exhibited lower incidence rates than Group D. The use of barbed sutures was associated with significantly shorter suture time and operative duration (all P  < 0.001), while maintaining equivalent cosmetic outcomes ( P  > 0.05). Conclusion The results of this study indicate that the use of barbed sutures for incision closure in TKA was not associated with an increased risk of major or minor wound complications. These findings suggest that barbed sutures may be considered a viable alternative for incision closure in TKA; however, careful application is advised when involving subcutaneous or adipose tissue. Clinical trial number: Not applicable.