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J Knee Surg
DOI: 10.1055/a-2607-9992
Original Article

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

Mina Mirzaiee 
1   Student Operating Room, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
,
Behzad Imani 
2   Department of Operating Room, Faculty of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran
,
Gholamreza Ghorbani Amjad 
3   Department of Orthopedics, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
,
Ali Reza Soltanian 
4   Modeling of Noncommunicable Diseases Research Center, Institute of Health Sciences and Technologies, Hamadan University of Medical Sciences, Hamadan, Iran
5   Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
,
Maryam Maddineshat 
5   Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
6   Chronic Diseases (Home Care) Research Center, Institute of Cancer, Hamadan University of Medical Sciences, Hamadan, Iran
7   Department of Nursing, School of Malayer Medical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
› Author Affiliations
Funding This project has received funding from the Vice-Chancellor for Research of Hamadan University of Medical Sciences 2023 research (Grant agreement: No.140203302392).
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Abstract

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.

Keywords

modified buried vertical mattress suture - tandem pulley stitch suture - subcuticular suture - modified vertical–horizontal buried suture - scar

Availability of Data and Material

This manuscript's data will not be deposited. The data are not publicly available due to privacy or ethical restrictions.


Code Availability

Not applicable.


Ethical Approval

The Ethics Committee and Research Council of Technology, the Hamadan University of Medical Sciences (IR.UMSHA.REC.1402.102) approved the study.


Consent for Publication

Informed consent: All the participants were informed about the study's objectives and stages, which were entirely voluntary, and the participants could leave at any stage.


Authors' Contributions

M. Maddineshat: Supervision, Conceptualization, Methodology, Data curation, Writing—original draft, Formal analysis, Visualization, Investigation, Software, Writing—review & editing. M. Mirzaiee: Conceptualization, Methodology, Formal analysis, Visualization, Investigation, Validation, Software, Writing—review & editing. B.I.: Supervision, Conceptualization, Methodology, Data curation, Writing—original draft, Review & editing. G.G.A.: Supervision, Writing—review & editing, Validation. A.R.S.: Conceptualization, Methodology, Data curation, Formal analysis, Supervision, Validation.




Publication History

Received: 23 February 2024

Accepted: 13 May 2025

Article published online:
12 June 2025

© 2025. Thieme. All rights reserved.

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