The Effect of Three Suture Techniques for Closure of Total Knee Arthroplasty: A Clinical Trial Study

Total knee replacement surgery may result in keloids and hypertrophic scars that cause pain and itching. Limited research on wound closure techniques has led to differing opinions among orthopedic surgeons about the best methods to minimize scarring. Our study compares three suture techniques-tandem pulley stitch, modified buried vertical mattress suture (MBVMS), and modified vertical-horizontal mattress suture-alongside subcuticular suture in total knee joint replacement surgeries. A single-blind randomized trial was conducted with 91 candidates for knee replacement surgery at Besat Hospital in Hamadan University of Medical Sciences from June to November 2023. The participants were divided into four groups-three interventions and one control-using a random block design of four. We evaluated the average scores for scar assessment and surgeon satisfaction using the Patient and Observer Scar Assessment Scale (POSAS) and the Visual Analog Scale (VAS). These evaluations were performed at 2 weeks, 6 weeks, and 3 months after the surgery. In each of the four study groups, the scar scores at all time intervals, as evaluated by both surgeons and patients, were lowest (best) for the following groups in order: modified buried vertical mattress, subcuticular, modified vertical-horizontal mattress, and tandem pulley stitch. In each of the four study groups, the VAS score was highest (better) across all time intervals among the patient groups, ranked in the following order: modified buried vertical mattress, subcuticular, modified vertical-horizontal mattress, and tandem pulley stitch. The present study showed that the MBVMS revealed better results in terms of scar scores, as well as surgeon and patient satisfaction. This suture can be a suitable alternative to the subcuticular suture in knee joint replacement surgeries.