scholarly journals Subcuticular sutures versus staples for skin closure after primary hip arthroplasty

2021 ◽  
Vol 87 (1) ◽  
pp. 55-64
Author(s):  
Hany Elbardesy ◽  
Rehan Gul ◽  
Shane Guerin
Keyword(s):  
Total Hip Arthroplasty ◽  
Systematic Reviews ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Random Effect ◽  
Cost Effective ◽  
Skin Closure ◽  
Patient’S Satisfaction ◽  
Total Hip ◽  
Significant Difference

High-quality and cost-effective health care are highly recommended especially in joint replacement surgeries, particularly in total hip arthroplasty. Therefore, it is indispensable for orthopaedic surgeons to spot the potential areas of quality improvement. Evaluating the efficacy of the different ways of skin closure is an unacknowledged topic. We performed this study following both the Preferred Reporting Items for Systematic Reviews and Meta- analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Articles were from any country, written in any language. We included all randomised control trials and retrospective cohort studies undergoing primary total hip arthroplasty who either received staples or subcuticular sutures for skin closure. The primary outcome was the incidence of wound infection. Secondary outcomes included length of stay (LOS), time to skin closure, total cost, and patient’s satisfaction. We included five studies in our cumulative meta- analysis. We conducted them using Review Manager V.5.0. We computed the risk ratio as a measure of the treatment effect, taking into account heterogeneity. We used Random-effect models. Primary skin closure with subcuticular sutures had insignificant marginal advantages for wound infections, LOS, and wound oozing. On the contrary, staples were more cost- effective and had less time for closure with higher patient’s satisfaction. Except for closure time and patient satisfaction , no significant difference between the two groups. The use of staples after THA may have several slight clinical advantages over the subcuticular sutures. However, owing to the complexities associated with wound closure, future clinical and laboratory studies assessing their complication outlines must be examined before an optimum technique can be determined.

scholarly journals Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Linbo Peng ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Junfeng Zeng ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Randomized Controlled ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the clinical, functional and radiographic outcomes of primary total hip arthroplasty between the direct anterior approach and posterior approach. Methods: We searched the PubMed, EMBASE databases and Cochrane library from the inception dates to November 1, 2019. And we also searched for the meta-analysis which was published in the past for randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants fulfilled the inclusion criteria. Among these, 301 and 299 patients were in the DAA and PA groups, respectively. DAA was associated with a longer surgery time by a mean of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). Postoperative early functional outcomes were significantly better in the DAA group than PA group such as Visual Analogue Scale (VAS) postoperative 1 day (MD=-0.65, 95% CI -0.91 to -0.38,p < 0.00001, I2=0%), VAS score postoperative 2 days (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05,I2=88%) and Harris Hip Score (HHS) postoperative 6 weeks(MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%).There was no significant difference between the DAA and PA groups at length of incision, length of stay(LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups about late functional outcomes such as VAS score postoperative 12 months or HHS scores postoperative 3, 6, 12 months. A significant difference in Radiographic outcomes can not be detected too. Conclusions: DAA needs longer surgery time than PA in primary total hip arthroplasty. The DAA offers better early functional recovery than PA. There is no significant difference between the two groups in terms of other clinical, complication, late functional and radiographic outcomes. The evidence about the superiority of DAA is insufficient, which needs more research.

scholarly journals Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Linbo Peng ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Junfeng Zeng ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Randomized Controlled ◽  
Vas Score ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes. Methods: We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials. Results: A total of 7 randomized controlled trials with 600 participants met the inclusion criteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I 2 =93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD=-0.65, 95% CI -0.91 to -0.38, p < 0.00001, I 2 =0%), VAS score at 2 days postoperatively (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05, I 2 =88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I 2 =52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected. Conclusions: The DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.

scholarly journals Staples Versus Sutures For Skin Closure In Hip Arthroplasty: A Meta-Analysis And Systematic Review

2021 ◽  
Author(s):  
Zirui Liu ◽  
Binfeng Liu ◽  
Hao Yang ◽  
Liang Zhao
Keyword(s):  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Operating Time ◽  
Cochrane Library ◽  
Skin Closure ◽  
Risk Of Infection ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Suture Group ◽  
Prolonged Discharge

Abstract Objective: The purpose of this present study was to estimate complication and other outcomes associated with staples and sutures closure after hip arthroplasty through meta- analysis techniques and system review. Methods: We searched for articles on EMBASE, PubMed, Medline, Web of Science and Cochrane Library. Eligibility of the searched trials. Cochrane Collaboration's Review Manager software is used to perform meta-analysis.Results: Four randomized controlled trials and one retrospective cohort trial chosen into our study. Our study indicated that the risk of infection and prolonged discharge higher with staples than with sutures for skin closure after hip arthroplasty. Meanwhile, there was no significant difference in allergic reaction, dehiscence, inflammation, abscess formation, Hollander Wound Evaluation Score and patient's satisfaction with skin closure methods between the two groups after hip arthroplasty. However, the suture group may require additional operating time.Conclusions: Closure with suture have a lower risk of infection and prolonged discharge when compared with staples skin closure in hip arthroplasty, while it may take more time.

scholarly journals Clinical, Functional and Radiographic Outcomes of Primary Total Hip Arthroplasty between Direct Anterior Approach and Posterior Approach: a Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Linbo Peng ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Junfeng Zeng ◽  
Yuan Liu ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Direct Anterior Approach ◽  
Total Hip ◽  
Randomized Controlled ◽  
Vas Score ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Primary Total Hip Arthroplasty

Abstract Background: The purpose of this systematic review and meta-analysis was to compare the direct anterior approach and posterior approach for primary total hip arthroplasty in terms of the clinical, functional and radiographic outcomes.Methods: We searched the PubMed and EMBASE databases and Cochrane Library from their inception to November 1, 2019. We searched for previously published articles and meta-analyses of randomized controlled trials.Results: A total of 7 randomized controlled trials with 600 participants met the inclusioncriteria. Among these patients, 301 and 299 were included in the DAA and PA groups, respectively. The DAA was associated with a longer surgery by a mean duration of 13.74 min (95% CI 6.88 to 20.61, p < 0.0001, I2=93%). The postoperative early functional outcomes were significantly better in the DAA group than in the PA group, such as the Visual Analogue Scale (VAS) score at 1 day postoperatively (MD=-0.65, 95% CI -0.91 to -0.38, p < 0.00001, I2=0%), VAS score at 2 days postoperatively (MD=-0.67, 95% CI -1.34 to -0.01, p =0.05, I2=88%) and Harris Hip Score (HHS) at 6 weeks postoperatively (MD=6.05, 95% CI 1.14 to 10.95, p =0.02, I2=52%). There was no significant difference between the DAA and PA groups in the length of the incision, hospital length of stay (LOS), blood loss, transfusion rates or complication rates. We found no significant difference between the two groups regarding late functional outcomes, such as the VAS score at 12 months postoperatively or the HHS scores at 3, 6, and 12 months postoperatively. A significant difference in the radiographic outcomes was not detected.Conclusions: The DAA requires a longer surgery time than does the PA in primary total hip arthroplasty. The DAA yields better early functional recovery than does the PA. There was no significant difference between the two groups in terms of other clinical, complication-related, late functional or radiographic outcomes. The evidence on the superiority of the DAA is insufficient and needs to be studied further.

A prospective randomised comparison of 2 skin closure techniques in primary total hip arthroplasty surgery

2017 ◽  
Vol 28 (1) ◽  
pp. 101-105 ◽  
Author(s):  
Min Rui ◽  
Xin Zheng ◽  
Shao-song Sun ◽  
Cheng-yu Li ◽  
Xing-chen Zhang ◽  
...  
Keyword(s):  
Clinical Study ◽  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Postoperative Hospital Stay ◽  
Skin Closure ◽  
Closure Technique ◽  
Subcuticular Suture ◽  
Patient’S Satisfaction ◽  
Significant Difference

Introduction: As an essential step of total hip arthroplasty (THA), an effective and secure skin closure technique after primary THA is important. Metallic staples closure and subcuticular suture are the 2 common techniques for skin closure. However, which closure technique is the optimal skin-closure method remains unclear. The purpose of this prospective randomised clinical study was to compare the clinical outcomes and costs between staples and subcuticular suture techniques. Methods: In this clinical study, 165 patients who underwent primary unilateral THA through a posterolateral approach from August 2014 to May 2015 were included. According to skin closure technique, the patients were randomised into staples group (interrupted suture with staples, 83 cases) and sutures group (running 4-0 absorbable subcuticular suture, 82 cases). The same operative and perioperative care were provided to all patients. The surgical site infections (SSIs) rate, closure time, time to dry wounds and postoperative hospital stay were recorded and compared. Besides, cosmetic results and patient’s satisfaction were evaluated with Hollander wound evaluation score (HWES) and VAS score at postoperative 3 months follow-up respectively. Relative total costs were recorded as well. Results: It was shown that no infections developed in sutures group, while 2 postoperative superficial infections (2.4%) occurred in the staples group. There was a statistically significant difference in the time to dry surgical incisions and postoperative hospital stay favoring sutures (4.8 vs. 5.0 days, p = 0.028; 6.0 vs. 12.0 days, p<0.001, respectively). The cutaneous incision closure using staples consumed significantly less time than that with subcuticular suture (24.7 vs. 357.7 seconds, p<0.001). Moreover, there was no significant difference in HWES and patient’s satisfaction between the 2 groups. Finally, the application of subcuticular suture saved an average of $82.2 per case. Conclusions: Closure with running subcuticular suture is cheaper and appears to have a clinical advantage when compared with metallic staples skin closure in primary THA surgery. However, additional operating time may be incurred.

scholarly journals Staples versus sutures for skin closure in hip arthroplasty: a meta-analysis and systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zirui Liu ◽  
Binfeng Liu ◽  
Hao Yang ◽  
Liang Zhao
Keyword(s):  
Systematic Review ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Operating Time ◽  
Cochrane Library ◽  
Skin Closure ◽  
Superficial Infection ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Prolonged Discharge

Abstract Objective The purpose of the present study was to estimate complications and other outcomes associated with staple and suture closure after hip arthroplasty through meta-analysis techniques and a systematic review. Methods We searched for articles in EMBASE, PubMed, Medline, Web of Science and the Cochrane Library. To determine the eligibility of the searched trials, Cochrane Collaboration's Review Manager software was used to perform the meta-analysis. Results Five randomized controlled trials and one retrospective cohort trial were included in our study. Our study indicated that for skin closure after hip arthroplasty, the risks of superficial infection and prolonged discharge were higher with staples than with sutures. There was no significant difference between the two groups in terms of allergic reaction, dehiscence, inflammation, abscess formation, the Hollander Wound Evaluation Scale or patient's satisfaction with skin closure methods. However, suturing required a longer operating time. Conclusions Closure with sutures is associated with lower risks of superficial infection and prolonged discharge than closure with staples following hip arthroplasty, but it may take more time.

scholarly journals Outpatient Total Hip Arthroplasty: A Meta-Analysis

2021 ◽  
Vol 11 (15) ◽  
pp. 6853
Author(s):  
Filippo Migliorini ◽  
Lucio Cipollaro ◽  
Francesco Cuozzo ◽  
Francesco Oliva ◽  
Andrea Valerio Marino ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Readmission Rates ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Outpatient Group ◽  
Operative Planning ◽  
The Mean ◽  
And Gender

Introduction: Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus databases were accessed in June 2021. All clinical studies investigating outpatient THA were considered. The outcomes of interest were pain, infection, mortality, revision, dislocation, readmission rates, and deep vein thrombosis (DVT). Results: Data from 102,839 patients were included. A total of 52% (153,168 of 102,839 patients) were women. The mean age of patients was 62.6 ± 4.6 years, the mean BMI was 29.1 ± 1.8 kg/m2. Good comparability was found in age, BMI, and gender (p > 0.1). No difference was found in pain (p = 0.4), infections (p = 0.9), mortality (p = 0.9), rate of revision (p = 0.1), dislocation (p = 0.9), and readmission (p = 0.8). The outpatient group demonstrated a greater rate of DVT (OR 3.57; 95% CI 2.47 to 5.18; p < 0.0001). Conclusions: In selected patients, outpatient THA can be performed safely with optimal outcomes comparable with inpatient THA. Clear and comprehensive pre-operative planning should involve a multi-disciplinary group composed of orthopaedic surgeons, anaesthesia and rehabilitation specialists, and physiotherapists. Each centre performing outpatient THA should implement continuous homecoming welfare activity, to supervise physiotherapy and monitor anticoagulant therapy.

Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis

2021 ◽  
pp. 112070002199111
Author(s):  
Jacob Shapira ◽  
Mitchell J Yelton ◽  
Jeffery W Chen ◽  
Philip J Rosinsky ◽  
David R Maldonado ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Comparable Efficacy ◽  
Total Hip ◽  
High Risk Patients ◽  
Randomised Control Trials ◽  
Risk Patients

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801–1.256; p = 0.489). Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

scholarly journals Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Georg Hauer ◽  
Maria Smolle ◽  
Sabrina Zaussinger ◽  
Joerg Friesenbichler ◽  
Andreas Leithner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Sick Leave ◽  
Return To Work ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Multivariate Linear Regression Analysis ◽  
Stem Design ◽  
Total Hip ◽  
Straight Stem ◽  
Significant Difference

AbstractReturn to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis

2021 ◽  
Author(s):  
Aaron Gazendam ◽  
Anthony Bozzo ◽  
Seper Ekhtiari ◽  
Colin Kruse ◽  
Nancy Hiasat ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Meta Analysis ◽  
Short Term ◽  
Total Hip
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