Biologic response to orthopedic sutures: a histologic study in a rabbit model

Biologic reactivity to suture materials can have an effect on patient outcomes. The goal of this study was to determine the histologic response to 8 commonly used orthopedic sutures--Ethibond (Ethicon, Somerville, New Jersey), Ticron (Tyco, Waltham, Massachusetts), HiFi (Linvatec, Largo, Florida), Ultrabraid (Smith & Nephew, Memphis, Tennessee), MaxBraid (Biomet, Warsaw, Indiana), Orthocord (Mitek, Raynham, Massachusetts), MagnumWire (Opus Medical, San Juan Capistrano, California), and FiberWire (Arthrex, Naples, Florida)--using a rabbit model. The suture granuloms were evaluated at 30, 60, and 120 days with measurement of the fibrous capsule, the number of giant cells in and near the capsule, and the overall inflammatory grade: 1 (mild), 2 (moderate), and 3 (severe). MagnumWire and Ticron sutures initiated a more intense inflammatory reaction when compared to the other sutures. By 120 days, MagnumWire (P=.0297) and Ticron (P=.1855) had fewer giant cells at the soft tissue-suture interface, fewer giant cells within the capsule (P=.0074 and P=.0377, respectively), and the greatest capsular thickness of all suture types (P<.0001 and P=.1378, respectively). Differences exist between the biologic reactivity of commonly used orthopedic sutures that may be attributable to their material composition and/or braid characteristics. In comparison to other high-strength sutures, MagnumWire and Ticron stimulated a more intense foreign body inflammatory response.