This article is more than 5 years old. Information may no longer be current.
Large study shows no effect of antibiotic-coated sutures on arthroplasty surgical site infection rates
The researchers found triclosan-coated sutures used in lower limb arthroplasty would increase the cost.
Click Here to Manage Email Alerts
BIRMINGHAM, England — Absorbable triclosan-coated sutures used in total hip and knee arthroplasty were not associated with any fewer surgical site infections than regular absorbable sutures, based on research that won the Best of the Best Award at the British Orthopaedic Association Congress, here.
“Our trial shows that coating the sutures in triclosan makes no difference in the surgical site infection rate following lower limb arthroplasty,” Cyrus D. Jensen, MB, BS, FRCS (T&O), Specialist Registrar in Trauma and Orthopaedics, Northern Deanery, United Kingdom, told Orthopaedics Today Europe. “Given the added costs without the added benefit, we cannot recommend use of these sutures, especially within a rationed health care system.”
Comparison of two sutures
The two sutures tested were the standard uncoated Vicryl suture and the Coated Vicryl Plus suture with Triclosan (V+) (both Ethicon Inc., Somerville, N.J., USA). Since the uncoated Vicryl suture was the more standard product, researchers used it in the control group, according to Jensen. Triclosan is a broad-spectrum antibacterial agent.
For the randomized controlled trial, Jensen and colleagues randomized 2,547 patients at a single institution with three sites to either the control group with uncoated Vicryl sutures or the study group with V+ sutures. Multiple surgeons performed the operations.
Nurses who were blinded to which sutures the patients had assessed both groups at 30 days for superficial or deep surgical site infections (SSIs). The researchers found no reduction in superficial or deep SSIs or a combination of the two, in either group. There were no statistically significant differences in demographics, premorbid states or comorbidities between the groups, according to Jensen.
“We had hoped these sutures would reduce our surgical site infection rate, providing us with a relatively easy change in practice to get a reduction in our infection rate,” he said.
Study limitations
Limitations of the study included the fact that all patients had only lower limb arthroplasty operations (total knee and hip replacements) and follow-up was done at 30 days.
“We only looked at lower limb arthroplasty operations, so care should be taken when extrapolating these findings into other fields of surgery,” Jensen told Orthopaedics Today Europe. “Some might feel that deep SSIs could present up to 1 year postoperatively and our 30-day follow-up might have missed a few late presenting deep infections. However, there is nothing to suggest that these missed late deep SSIs would alter the overall findings of equivalence of the two suture types.”
Jensen and colleagues plan to review SSI rates in both groups at 1 year.
The researchers estimated that using antibacterial-coated sutures for the nearly 180,000 hip and knee replacements performed in the United Kingdom annually would add as much as £800,000 more to the cost of those procedures.
“The added cost of using Vicryl Plus sutures could not be justified, as we found no benefit in terms of reduction in SSI in the lower limb arthroplasty setting,” Jensen said. – by Renee Blisard Buddle
- Reference:
- Jensen C. Effect of triclosan-coated sutures on the incidence of surgical site infection following lower limb arthroplasty: A double-blind, randomised controlled trial of 2547 procedures. Presented at: British Orthopaedic Association Congress. Oct.1-4, 2013. Birmingham, England.
- For more information:
- Cyrus D. Jensen, MB, BS, FRCS (T&O), can be reached at Leeds General Hospital, Great George Street, Leeds, West Yorkshire, LS1 3EX United Kingdom; email: jensen@doctors.org.uk.
Disclosure: Jensen has no relevant financial disclosures.