Knotless Suture in Revision Total Joint Arthroplasty

NCT ID: NCT04403919

Last Updated: 2024-04-17

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

81 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-01

Study Completion Date

2023-06-01

Brief Summary

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Barbed suture has been demonstrated to be safe in primary hip and knee surgery and retrospective data suggests barbed suture represents no increased complications in the revision setting. Barbed suture may represent a faster, more effective way to perform revision arthroplasty closures. There are no Level I studies comparing traditional and barbed suture closure. The purpose of this study is to assess the surgical complexities of closures using closure time without sacrificing cosmesis or wound complications between the traditional closure and barbed closure.

Detailed Description

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Conditions

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Arthroplasty

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

prospective, randomized, controlled trial, parallel four-arm design, single-center study
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Revision total knee arthroplasty: control

Group Type ACTIVE_COMPARATOR

Conventional Closure: Knee

Intervention Type DEVICE

Traditional closure will consist of arthrotomy (deep layer) closed with figure of eight number 1 vicryl plus followed by closure of the intermediate layer with 0 Vicryl plus. The intermediate layer will be performed at surgeon's discretion especially in thin patients. Subdermal layer with 2-0 vicryl suture followed by subcuticular 3-0 monofilament suture (monocryl PLUS, Ethicon; Johnson \& Johnson) and Dermabond advanced.

Revision total knee arthroplasty: active

Group Type EXPERIMENTAL

Barbed suture closure: Knee

Intervention Type DEVICE

The barbed suture closure will consist of number 2 Stratafix symmetric PDS PLUS for the arthrotomy, intermediate layer will be performed at surgeon's discretion in thin patients, if performed will entail stratafix spiral, subdermal 2-0 stratafix spiral monocryl plus. Followed by subcuticular 3-0 stratafix spiral monocryl plus suture and Dermabond advance.

Revision Total Hip Arthroplasty: control

Group Type ACTIVE_COMPARATOR

Conventional Closure: Hip

Intervention Type DEVICE

1. The capsule will be closed with Vicryl Plus number 1
2. Deep fascia with figure of eight interrupted number 1 braided absorbable suture (Vicryl plus, Ethicon; Johnson \&Johnson, Somerville, NJ)
3. Subdermal fat layer simple interrupted knots using number 2-0 braided absorbable sutures (Vicryl plus)
4. Subcuticular 3-0 monofilament suture (monocryl plus , Ethicon; Johnson \& Johnson)
5. followed by the use of skin adhesive (Dermabond Advanced, Ethicon; Johnson \&Johnson).

Revision Total Hip Arthroplasty: active

Group Type EXPERIMENTAL

Barbed suture closure: Hip

Intervention Type DEVICE

1. The capsule will be closed with stratafix symmetric PDS Plus
2. Deep fascia will be closed with Stratafix Symmetric PDS Plus (Stratafix symmetric PDS plus, Ethicon; Johnson \&Johnson, Somerville, NJ)
3. Subdermal layer with running number 2-0 barbed suture (stratafix spiral monocryl plus, Ethicon; Johnson \& Johnson, Somerville, NJ)
4. Subcuticular suture with stratafix spiral monocryl plus, Ethicon
5. followed by the use of skin adhesive (Dermabond advanced, Ethicon; Johnson \&Johnson).

Interventions

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Conventional Closure: Knee

Traditional closure will consist of arthrotomy (deep layer) closed with figure of eight number 1 vicryl plus followed by closure of the intermediate layer with 0 Vicryl plus. The intermediate layer will be performed at surgeon's discretion especially in thin patients. Subdermal layer with 2-0 vicryl suture followed by subcuticular 3-0 monofilament suture (monocryl PLUS, Ethicon; Johnson \& Johnson) and Dermabond advanced.

Intervention Type DEVICE

Barbed suture closure: Knee

The barbed suture closure will consist of number 2 Stratafix symmetric PDS PLUS for the arthrotomy, intermediate layer will be performed at surgeon's discretion in thin patients, if performed will entail stratafix spiral, subdermal 2-0 stratafix spiral monocryl plus. Followed by subcuticular 3-0 stratafix spiral monocryl plus suture and Dermabond advance.

Intervention Type DEVICE

Conventional Closure: Hip

1. The capsule will be closed with Vicryl Plus number 1
2. Deep fascia with figure of eight interrupted number 1 braided absorbable suture (Vicryl plus, Ethicon; Johnson \&Johnson, Somerville, NJ)
3. Subdermal fat layer simple interrupted knots using number 2-0 braided absorbable sutures (Vicryl plus)
4. Subcuticular 3-0 monofilament suture (monocryl plus , Ethicon; Johnson \& Johnson)
5. followed by the use of skin adhesive (Dermabond Advanced, Ethicon; Johnson \&Johnson).

Intervention Type DEVICE

Barbed suture closure: Hip

1. The capsule will be closed with stratafix symmetric PDS Plus
2. Deep fascia will be closed with Stratafix Symmetric PDS Plus (Stratafix symmetric PDS plus, Ethicon; Johnson \&Johnson, Somerville, NJ)
3. Subdermal layer with running number 2-0 barbed suture (stratafix spiral monocryl plus, Ethicon; Johnson \& Johnson, Somerville, NJ)
4. Subcuticular suture with stratafix spiral monocryl plus, Ethicon
5. followed by the use of skin adhesive (Dermabond advanced, Ethicon; Johnson \&Johnson).

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Patients ≥ 18 years of age
2. Surgical candidates undergoing revision total knee or total hip arthroplasty for one of the following indications second stage of two stage reimplantation for infection, mechanical loosening, instability, polyethylene wear, stiffness, or periprosthetic fracture

Exclusion Criteria

1. Patient is ≤ 18 years of age
2. Patient is unable to provide written consent
3. Patient has active infections in the operative leg/joint
4. Known Allergy to Suture material
5. Underlying Dermatological diseases affecting surgical site including dermatitis, eczema, or psoriasis; connective tissue or vascular disorders or diseases that would adversely affect wound healing; metastatic cancer; renal insufficiency (dialysis); steroid dependence; malnourishment; and other disease processes resulting in an immunocompromised state. Diabetes, smoking and obesity will be allowed as they are frequent comorbidities in our revision joint population
6. Anterior total hip replacement
7. Stage 1 of two stage revision for infection
8. Closure performed by plastic surgeon, including flap coverage

Vulnerable populations will not be enrolled in this study.

Withdrawal Criteria

1. Failure to attend regularly scheduled follow up appointments
2. Deviation from closure protocol
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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NYU Langone Health

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ran Schwarzkopf, MD

Role: PRINCIPAL_INVESTIGATOR

NYU Langone Health

Locations

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NYU Langone Health

New York, New York, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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20-00280

Identifier Type: -

Identifier Source: org_study_id

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