Background: Wound closure is one of the crucial aspects of total knee arthroplasty (TKA) for patients who perform high-flexion activities of daily living, because the joint capsule is highly stretched and integrity of the arthrotomy closure must be maintained. Watertightness of the knee joint is a different aspect of the repair integrity of arthrotomy closure and is being noticed with increasing usage of the drain clamp method for blood management after TKA. Recently, the barbed knotless suture has been growing in popularity as a strong, secure closure appropriate for high-tension areas, such as the fascia and joint capsule. The purpose of this study was to compare the barbed knotless suture with simple interrupted suture in cadaveric knees. Methods: Nine fresh-frozen cadaveric lower extremities were used. After placing a parapatellar incision and setting a closed suction drain, arthrotomies were closed randomly using three suture materials: simple interrupted absorbable suture (No. 0 PDS, group C); or a single running knotless barbed suture Stratafix with 8N (group BS-8N) or 15N (group BS-15N) of tension. After arthrotomy closure, saline was injected in a retrograde manner into the joint through a drain until saline started to leak from the joint. Peak values for intra-articular pressure and infusion volume in each group were recorded and compared. Results: Mean infusion volumes were 13.0 ± 7.2 ml, 38.6 ± 10.7 ml, and 5.1 ± 2.5 ml in groups BS-8N, BS-15N, and C, respectively. Mean intra-articular pressures were 0.67 ± 0.47 kPa, 9.44 ± 4.55 kPa, and 0.56 ± 0.44 kPa in groups BS-8N, BS-15N, and C, respectively. Infusion volume and joint internal pressure were significantly higher in group BS-15N than in groups BS-8N (p = 0.008) or C (p = 0.04). Conclusions: Barbed suture with 15N appears appropriate for maintaining maximal watertightness after knee joint capsule closure, offering successful drain clamping, higher resistance to early mobilization protocols, and subsequent achievement of early deep knee flexion after TKA.
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