A Prospective Single-blinded Randomized Controlled Study Evaluating Efficacy of Tissue Adhaesive in Wound Closure Following Primary Total Knee Arthroplasty

Prolonged wound drainage following total joint replacement surgery has been shown to be a predictor of Periprosthetic Joint Infection (PJI) 1-3. Several studies have highlighted this subject, and estimates of the risk of postoperative infection range from 1.3% to 50% among patients with persistent wound drainage 4. Such infections can be one of the most challenging complications following joint replacement surgery and is one of the leading causes of revision surgery following primary hip and knee arthroplasty 5,6.

Several patient-related factors have been associated with delayed wound healing and increased risk of infection following joint replacement surgery. Obesity 4,7, diabetes 8, smoking 9,10 and autoimmune disease 11 have been shown to have a detrimental effect on wound healing. Recently there has also been reports that patients with hypertension 12 have impaired wound healing following total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Surgery related factors such as surgical approach, pneumatic tourniquet time and use of peri-articular local anesthesia have also been shown to have an effect on postoperative wound oozing 9,13.

Finally, several pharmacological factors, such as thromboembolic chemoprophylaxis 4, steroid treatment 9,14 and possibly statins 15,16 might also influence wound healing.

In recent years tissue adhesives for wound closure have been introduced as a replacement or a supplement to conventional closure techniques. Currently very few studies investigate the effect of such tissue adhesives in Total Knee Arthroplasty, and high quality randomized controlled trials (RCT) are lacking.