Advanced Multi-Layer, Watertight Closure in Total Joint Replacement: A Retrospective Study

OBJECTIVES: In total joint replacement procedures, surgeons have increasingly adopted an advanced multi-layer, watertight closure (aMLWC) using knotless barbed sutures and 2-octyl cyanoacrylate adhesive combined with a polyester mesh. The objective of the study was to compare the clinical and economic outcomes for aMLWC patients to those with conventional closure (CC) with sutures and skin staples.

METHODS: Patients aged ≥18 years were included in the study if they had undergone total joint arthroplasty of the hip or knee (TJA) as elective, primary procedures during an inpatient admission occurring between January 2014 and March 2019. aMLWC and CC cohorts were compared using multivariable regression analysis of SSIs, length-of-stay, OR time, procedure time, discharge status, readmissions, reoperations, and ED visits.

RESULTS: A total of 1828 patients received at least one TJA procedure, of which 434 (23.7%) involved aMLWC and 1394 (76.3%) involved CC. Unadjusted time-to-readmission, when occurring, was considerably longer following aMLWC (89.9 vs. 51.1 days, P<0.0001), and a lower proportion of aMLWC patients required reoperations within 90 days (0.0% vs 2.6%, P<0.0001). Adjusted mean hospital LOS was approximately half day shorter for aMLWC patients (1.10 versus 1.65 days; P<0.001), and aMLWC patients were more likely to be discharged to home (Odds Ratio: 4.61; P=0.002).

CONCLUSIONS: Among patients undergoing total hip and knee arthroplasty in a highly optimized real-world clinical practice, aMLWC was associated with significantly shorter inpatient LOS and increased likelihood of being discharged to home as compared with conventional closure. These findings suggest that performing aMLWC is paramount in all total hip and total knee replacements, including high-risk optimized patients, to facilitate shorter LOS and the ability to discharge to home.