Tissue adhesives for total knee arthroplasty wounds: A randomised controlled trial

Abstract

Introduction: Patients who undergo total knee arthroplasty (TKA) conventionally receive wound dressing and are advised against water contact for 2 weeks after surgery. Cyanoacrylate tissue adhesive (CTA) is waterproof and provides a physical barrier to microbial penetration; therefore, we aimed to assess its efficacy and safety for TKA wounds. Methods: A total of 75 patients receiving primary TKA were randomised to receive either CTA, CTA with mesh, or steristrips, with 25 patients per group. The TKA wounds were closed in three standard layer sutures using barbed sutures for arthrotomy, subcutaneous, and subcuticular layers. Patients who received CTA were encouraged to shower without covering the wound from day 3 after surgery onwards. A logbook was given to patients to record the frequency of showering and wound coverage. Wound oozing, bruising, allergic reactions, and Southampton Wound Scale score at day 14 were documented. Results: All wounds healed at 2 weeks without infection. Mild blood staining of the outer dressing was observed in 28%, 37.5%, and 56.5% of patients the in CTA, CTA with mesh, and steristrip groups, respectively, and all resolved spontaneously. In all, 83.3%, 83.3%, and 56.5% patients, respectively, reported showering within 2 weeks. In total, 55% of CTA with mesh and 35% of CTA patients had wounds uncovered during showering as instructed. The mean number of times showered within 2 weeks was 7.8, 8.2, and 5.5 for the CTA, CTA with mesh, and steristrip groups, respectively. Conclusions: The CTA reduces wound oozing and allows patients to safely shower without increasing risk of infection or delaying wound healing.