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Subcuticular Sutures Outperform Staples in Early Wound Healing After Minimally Invasive Anterolateral Total Hip
Thomas Stumpner1, Jakob Wallner2, Martin Bischofreiter1
1Department of Orthopedic Surgery, Ordensklinikum Barmherzige Schwestern, Linz, Austria, Vinzenzgruppe Center of Orthopedic Excellence, Teaching Department of the Paracelsus Medical University Salzburg, Austria.
Background:
Wound complications remain a major concern after total hip arthroplasty (THA), as they delay mobilization, prolong hospitalization, and increase infection risk. Evidence on wound closure for the minimally invasive anterolateral approach is limited. Therefore, this study compared skin stapling and subcuticular suture closure regarding early wound healing and scar quality after minimally invasive anterolateral THA.
Methods:
A total of 583 consecutive patients undergoing short-stem THA via minimally invasive anterolateral approach were retrospectively analyzed. All procedures used identical implants, perioperative protocols, and wound management. Procedures differed only in skin closure, using either staples or absorbable subcuticular sutures. Primary outcome was early wound condition, defined by secretion, erythema, and time until the wound was considered unremarkable. Secondary outcomes included revision for wound complications, early implant revision, length of hospital stay, and scar quality.
Results:
Use of subcuticular sutures resulted in a significantly shorter duration of erythema (P = .049), earlier achievement of a bland wound (P < .001), and a lower rate of prolonged wound secretion (≥7 days) than staples (0.69% vs 3.73%; P = .021; Odds Ratio (OR) 5.54). Hospital stay was shorter after sutures (6.1 ± 2.0 vs 7.0 ± 3.3 days; P < .001). Rates of wound revision and early implant revision tended to be lower in the suture group, without statistical significance. Scar quality was comparable between groups.
Conclusions:
Subcuticular suture closure was associated with improved early wound healing and earlier hospital discharge after minimally invasive anterolateral THA. These findings suggest a potential advantage which should be further evaluated in prospective randomized trials.
