Barbed versus traditional sutures in primary total knee arthroplasty: systematic review and meta-analysis of clinical outcomes and wound-related complications
- 1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- 2King Abdullah International Medical Research Center (KAIMRC), Jeddah, Saudi Arabia
- 3Orthopedic Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
Abstract
Background: Despite the widespread use of total knee arthroplasty (TKA), the optimal wound closure technique remains clinically unresolved. Barbed sutures have been proposed as a knotless alternative to traditional sutures, with potential advantages in operative efficiency and wound closure; however, concerns remain regarding postoperative complications. This systematic review and meta-analysis aimed to compare the clinical outcomes and postoperative complications associated with barbed versus traditional sutures in patients undergoing primary TKA.
Methods: A comprehensive literature search was conducted using MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Scopus, and Embase from database inception through November 2025. Eligible studies were restricted to randomized controlled trials (RCTs) involving adults undergoing primary TKA that directly compared barbed with traditional (knotted) sutures and reported at least one predefined clinical or wound-related outcome. Primary outcomes included wound closure time, superficial wound infection, postoperative Knee Society Score (KSS), knee range of motion (ROM), and wound-related adverse events. Meta-analysis was performed using RevMan version 5.3. The study was registered in PROSPERO (CRD420251128395) and received Institutional Review Board (IRB) approval from King Abdullah International Medical Research Center (Protocol No. NRJ25/044/8).
Results: Five randomized controlled trials involving 1035 patients mettheeligibilitycriteria. Barbed sutures appeared to be associated with shorter wound closure times (MD = − 5.39 min, 95% CI: − 9.89 to − 0.88; P = 0.02). However, substantial heterogeneity was observed across studies. Superficial wound infection was significantly more frequent with barbed sutures (OR = 2.33, 95% CI: 1.07–5.05; P = 0.03). No significant differences were observed in postoperative KSS at 6 weeks and 3 months (MD = 0.42, 95% CI: − 0.88 to 1.72; P = 0.53).
Conclusion: Barbed sutures may reduce wound closure time during TKA but are associated with a higher risk of superficial wound infection. No significant differences were observed in early functional outcomes, and further high-quality studies are needed to clarify long-term safety and efficacy.
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BibTeX
@article{babtain2026barbed,
title = {{Barbed versus traditional sutures in primary total knee arthroplasty: systematic review and meta-analysis of clinical outcomes and wound-related complications}},
author = {Hamed W. Babtain and Abdalmalik T. Malki and Awwab A. Shahhatalsayed and Basmah S. Alweal and Retal E. Faidah and Anas M. Alqarni and Loai A. Alsulaimani and Abdulrahman H. Albadri and Muath S. Alqahtani and Dhafer S. Almuffarh},
journal = {Journal of Orthopaedic Surgery and Research},
year = {2026},
month = jun,
doi = {10.1186/s13018-026-07036-3},
url = {https://doi.org/10.1186/s13018-026-07036-3},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Barbed versus traditional sutures in primary total knee arthroplasty: systematic review and meta-analysis of clinical outcomes and wound-related complications
AU - Hamed W. Babtain
AU - Abdalmalik T. Malki
AU - Awwab A. Shahhatalsayed
AU - Basmah S. Alweal
AU - Retal E. Faidah
AU - Anas M. Alqarni
AU - Loai A. Alsulaimani
AU - Abdulrahman H. Albadri
AU - Muath S. Alqahtani
AU - Dhafer S. Almuffarh
PY - 2026
DA - 2026/06/28
JO - Journal of Orthopaedic Surgery and Research
DO - 10.1186/s13018-026-07036-3
UR - https://doi.org/10.1186/s13018-026-07036-3
AB - Background: Despite the widespread use of total knee arthroplasty (TKA), the optimal wound closure technique remains clinically unresolved. Barbed sutures have been proposed as a knotless alternative to traditional sutures, with potential advantages in operative efficiency and wound closure; however, concerns remain regarding postoperative complications. This systematic review and meta-analysis aimed to compare the clinical outcomes and postoperative complications associated with barbed versus traditional sutures in patients undergoing primary TKA. Methods: A comprehensive literature search was conducted using MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Scopus, and Embase from database inception through November 2025. Eligible studies were restricted to randomized controlled trials (RCTs) involving adults undergoing primary TKA that directly compared barbed with traditional (knotted) sutures and reported at least one predefined clinical or wound-related outcome. Primary outcomes included wound closure time, superficial wound infection, postoperative Knee Society Score (KSS), knee range of motion (ROM), and wound-related adverse events. Meta-analysis was performed using RevMan version 5.3. The study was registered in PROSPERO (CRD420251128395) and received Institutional Review Board (IRB) approval from King Abdullah International Medical Research Center (Protocol No. NRJ25/044/8). Results: Five randomized controlled trials involving 1035 patients mettheeligibilitycriteria. Barbed sutures appeared to be associated with shorter wound closure times (MD = − 5.39 min, 95% CI: − 9.89 to − 0.88; P = 0.02). However, substantial heterogeneity was observed across studies. Superficial wound infection was significantly more frequent with barbed sutures (OR = 2.33, 95% CI: 1.07–5.05; P = 0.03). No significant differences were observed in postoperative KSS at 6 weeks and 3 months (MD = 0.42, 95% CI: − 0.88 to 1.72; P = 0.53). Conclusion: Barbed sutures may reduce wound closure time during TKA but are associated with a higher risk of superficial wound infection. No significant differences were observed in early functional outcomes, and further high-quality studies are needed to clarify long-term safety and efficacy.
SN - 1749-799X
ER -