Abstract
Background
Wound complications remain a major concern after total hip arthroplasty (THA), as they delay mobilization, prolong hospitalization, and increase infection risk. Evidence on wound closure for the minimally invasive anterolateral approach is limited. Therefore, this study compared skin stapling and subcuticular suture closure regarding early wound healing and scar quality after minimally invasive anterolateral THA.
Methods
A total of 583 consecutive patients undergoing short-stem THA via minimally invasive anterolateral approach were retrospectively analyzed. All procedures used identical implants, perioperative protocols, and wound management. Procedures differed only in skin closure, using either staples or absorbable subcuticular sutures. Primary outcome was early wound condition, defined by secretion, erythema, and time until the wound was considered unremarkable. Secondary outcomes included revision for wound complications, early implant revision, length of hospital stay, and scar quality.
Results
Use of subcuticular sutures resulted in a significantly shorter duration of erythema (P = .049), earlier achievement of a bland wound (P < .001), and a lower rate of prolonged wound secretion (≥7 days) than staples (0.69% vs 3.73%; P = .021; Odds Ratio (OR) 5.54). Hospital stay was shorter after sutures (6.1 ± 2.0 vs 7.0 ± 3.3 days; P < .001). Rates of wound revision and early implant revision tended to be lower in the suture group, without statistical significance. Scar quality was comparable between groups.
Conclusions
Subcuticular suture closure was associated with improved early wound healing and earlier hospital discharge after minimally invasive anterolateral THA. These findings suggest a potential advantage which should be further evaluated in prospective randomized trials.
Keywords: Hip arthroplasty, Skin closure, Suture, Staple, Anterolateral, Minimally invasive
Introduction
Total hip arthroplasty (THA) revolutionized orthopaedic surgery, restoring mobility and quality of life for millions of patients with continuously rising case numbers. Advances in materials, design, and surgical techniques have enhanced durability, stability, and recovery, making it the "Operation of the Century" [1].
Wound complications are a major concern in the early postoperative phase as they hinder early mobilization, prolong hospital stay, and increase the risk of deep infections and prosthesis failure. Therefore, proper skin closure is essential for rapid recovery, minimizing risk for major complications and optimal cosmetic results [2]. Recent studies also emphasize its role in reducing hospital costs [[3], [4], [5]].
The choice of skin closure in arthroplasty is predominantly based on the personal experience of surgeons [6]. Literature indicates a potential advantage of suture closure in terms of faster wound healing and reduced wound complications [4,5]. However, most studies evaluating skin closure technique have been conducted using a lateral or posterolateral surgical approach, or do not specify the approach [4,5,[7], [8], [9], [10], [11], [12], [13]]. Compared to the posterior approach, the anterior approach has been associated with an increased risk of infection [14]. Additionally, in obese patients, the anterolateral approach carries a higher infection risk than lateral approaches [15], highlighting the necessity of achieving uncomplicated wound healing in anterior-based approaches.
Until December 2023, skin closure after THA at our institution was routinely performed using skin staples. Based on the above-mentioned recommendations, the standard skin closure technique was changed to resorbable subcuticular sutures starting in January 2024. Accordingly, the purpose of this study was to assess the effect of skin closure technique on early wound healing and cosmetic outcomes following minimally invasive anterolateral THA. We hypothesized that subcuticular sutures would be associated with improved early wound healing and superior cosmetic outcomes than staples.
Material and methods
This study represents a retrospective before–after observational cohort study evaluating a change in institutional skin closure practice from staple closure to running subcuticular sutures. Postoperative data from consecutive patients treated at our arthroplasty center were retrospectively analyzed. In addition, a prospective assessment of scar formation was performed. The study included all patients who underwent primary short-stem THA via a minimally invasive anterolateral approach between January 2023 and June 2024. Patients who underwent revision surgeries, received prostheses for fractures, or had implants placed using a surgical approach other than anterolateral were excluded. Approval was obtained by the institutional ethics committee of the Medical Faculty of the Johannes Kepler University Linz (EK Nr. 1230/2024).
All procedures were performed by or in the presence of a senior surgeon. Single-shot antibiotic prophylaxis was administered with cefuroxime (1.5 g i.v.) 30 min before skin incision. A cementless, calcar-guided short stem combined with an isoelastic monobloc polyethylene cup and a ceramic head was used (Vitamys/Optimys/Ceramys; Mathys AG, Bettlach, Switzerland).
Wound closure was performed by the operating surgeon according to institutional standard in both groups. The fascia was closed using continuous absorbable barbed sutures (Stratafix; J&J Medical). The subcutaneous layer was closed using interrupted absorbable sutures (Vicryl 0; J&J Medical). Skin closure differed between groups: in the staple group, metal staples (Appose; Medtronic, Watford, UK) were used, whereas in the suture group, skin closure was performed using a running absorbable subcuticular suture (Monocryl 4-0, J&J Medical, Norderstedt, Germany).
Postoperative care, ward routines, mobilization, and discharge criteria followed a standardized institutional protocol and remained unchanged during the study period. Wound care was performed using a transparent film dressing with a honeycomb foam pad, allowing wound assessment without routine dressing changes. Patients were mobilized starting on the first postoperative day. Discharge was possible once patients were independently mobile with the aid of crutches, able to climb stairs, no longer required morphine for pain management, and the wound was dry and considered unremarkable.
Postoperative wound assessment was performed daily by board-certified orthopaedic surgeons permanently assigned to specific inpatient wards, ensuring continuous oversight of the postoperative course. Wound status was documented using a standardized electronic chart with predefined selectable fields, recording wound secretion (dry, bloody, serous), and wound edge erythema, thereby enabling consistent and standardized documentation.
Data collection was carried out by an independent reviewer who was not involved in patient management or statistical analysis. The primary outcome parameter was wound status. A bland wound was defined as dry, without oozing, and without significant wound edge redness. Additionally, we assessed the rate of surgical intervention for superficial wound healing disorders (revision or secondary suturing), the need for prolonged antibiotic prophylaxis due to wound healing concerns, duration of hospital stay, and early component revision rate (<30 days).
Scar formation was assessed using the patient-reported component of the validated Patient and Observer Scar Assessment Scale [16] and a subjective scar satisfaction rating.
Statistical analysis
A multistage statistical procedure was applied to generate the presented results. The analysis initially focused on determining whether relevant demographic differences existed between the 2 treatment groups (staple vs suture). Metric variables were described for the total sample and for each treatment group separately using measures of central tendency and dispersion. For categorical variables—such as sex, Body Mass Index (BMI) categories, or the presence of risk factors (eg, diabetes mellitus, renal insufficiency)—absolute (n) and relative frequencies (percentages) were calculated and compared. To identify group differences, Chi-square tests were used for categorical variables. In cases with small expected cell frequencies (<5), for example, in rare diagnoses such as type 1 diabetes mellitus, Fisher’s exact test was applied. For continuous variables, such as age, the two-sample t-test was used (Table 1).
Table 1.
Demographic data and risk factors for impaired wound healing.
| Variable | Overall | Staple | Suture | P value |
|---|---|---|---|---|
| n | 583 | 295 | 288 | |
| Sex | .075a | |||
| Male | 239 (41.0) | 132 (44.7) | 107 (37.3) | |
| Female | 344 (59.0) | 163 (55.3) | 181 (62.7) | |
| Age at surgery (SD) | 67.3 (10.1) | 67.7 (10.4) | 66.8 (9.8) | .286c |
| BMI (%) | .214a | |||
| <30 | 410 (70.3) | 214 (72.5) | 196 (68.1) | |
| 30-34.99 | 125 (21.4) | 61 (20.7) | 64 (22.2) | |
| 35-39.99 | 38 (6.5) | 18 (6.1) | 20 (6.9) | |
| ≥40 | 10 (1.7) | 2 (0.7) | 8 (2.8) | |
| DM1 (%) | 3 (0.5) | 3 (1.0) | 0 (0.0) | .256b |
| DM2 (%) | 57 (9.8) | 33 (11.2) | 24 (8.3) | .308a |
| CHD (%) | 44 (7.5) | 24 (8.1) | 20 (6.9) | .698a |
| PAD (%) | 13 (2.2) | 10 (3.4) | 3 (1.0) | .101a |
| CHF (%) | 12 (2.1) | 9 (3.1) | 3 (1.0) | .157a |
| COPD (%) | 23 (3.9) | 11 (3.7) | 12 (4.2) | .953a |
| Renal insufficiency (%) | 23 (3.9) | 17 (5.8) | 6 (2.1) | .039a |
| Immunosuppression (%) | 12 (2.1) | 5 (1.7) | 7 (2.4) | .739a |
| Nicotine abuse (%) | 48 (8.2) | 30 (10.2) | 18 (6.2) | .116a |
DM1, diabetes mellitus type 1; DM2, diabetes mellitus type 2; CHD, cardiovascular heart disease; PAD, peripheral arterial disease; CHF, chronic heart failure; COPD, chronic obstructive pulmonary disease.
Chi-square test.
Fisher's exact test.
Two-sample t-tests.
The main focus of the analysis was the identification of significant differences between the 2 treatment groups with respect to relevant outcome measures. The choice of statistical tests followed the same principles as for the demographic variables, depending on the scale level and distribution of the data. As the metric outcome variables were not normally distributed, the nonparametric Mann–Whitney U test was applied (Table 2).
Table 2.
Early postoperative wound characteristics.
| Variable | Overall | Staple | Suture | P value |
|---|---|---|---|---|
| n | 583 | 295 | 288 | |
| Surgery site (%) | .250a | |||
| Left | 264 (45.3) | 141 (47.8) | 123 (42.7) | |
| Right | 319 (54.7) | 154 (52.2) | 165 (57.3) | |
| Fever ≥38.5° [days] (SD) | 0.0 (0.2) | 0.0 (0.0) | 0.0 (0.3) | .188c |
| Redness of the wound [days] (SD) | 0.1 (1.1) | 0.2 (1.6) | 0.0 (0.2) | .049c |
| Serous secretion [days] (SD) | 0.5 (2.4) | 0.8 (2.7) | 0.2 (1.9) | .001c |
| Bloody secretion [days] (SD) | 0.4 (1.7) | 0.5 (2.2) | 0.2 (1.0) | .009c |
| Secretion ≥7 days (%) (bloody and/or serous) | 13 (2.2) | 11 (3.73) | 2 (0.69) | .021b |
| Prolonged AB administration [days] (SD) | 1.0 (9.3) | 1.1 (8.5) | 0.9 (10.1) | .814c |
| Wound bland from day … (SD) | 0.8 (2.7) | 1.3 (3.1) | 0.4 (2.1) | <.001c |
| Wound revision (%) | 5 (0.9) | 4 (1.4) | 1 (0.3) | .3842 |
| Secondary suture (%) | 3 (0.5) | 3 (1.0) | 0 (0.0) | .256b |
| Length of stay [days] (SD) | 6.6 (2.8) | 7.0 (3.3) | 6.1 (2.0) | <.001c |
| Early implant revision (%) | 10 (1.7) | 7 (2.3) | 3 (1.0) | .358a |
| ≤30d germ detection (%) | 7 (1.2) | 4 (1.4) | 3 (1.0) | 1.000a |
Chi-square test.
Fisher's exact test.
Mann–Whitney U test.
Scar assessment was performed using the independent-samples t-test (Table 4).
Table 4.
Scar assessment and subjective satisfaction with scar formation.
| Variable | Overall | Staple | Suture | P valuea |
|---|---|---|---|---|
| N. | 380 | 183 | 197 | |
| Follow-up (mo) | 21.4 (4.3) | 23.6 (3.9) | 19.4 (3.6) | <.001 |
| Scar pain | 0.8 (1.6) | 0.8 (1.5) | 0.8 (1.7) | .764 |
| Scar itching | 0.6 (1.2) | 0.6 (1.1) | 0.7 (1.2) | .469 |
| Scar color | 2.8 (1.8) | 2.9 (1.8) | 2.7 (1.7) | .226 |
| Scar stiffness | 1.4 (1.8) | 1.4 (1.7) | 1.5 (1.9) | .567 |
| Scar thickness | 1.5 (1.8) | 1.5 (1.7) | 1.4 (2.0) | .446 |
| Scar irregularity | 1.3 (1.8) | 1.2 (1.7) | 1.3 (1.8) | .622 |
| Satisfaction | 1.2 (1.7) | 1.2 (1.7) | 1.1 (1.6) | .455 |
Scale: 0 = best outcome| 10 = worst outcome.
Mean (SD).
T-test for independent samples.
All results were interpreted based on the calculated P values. A P value <.05 was considered statistically significant. Due to the retrospective study design, no a priori sample size calculation was performed.
Results
A total of 583 patients were included in the study (295 staple, 288 suture). Both groups showed a nonsignificant predominance of female patients. Median age in all patients was 67.3 years, and 70.3% of patients had a BMI below 30 kg/m2. There were no significant differences in baseline demographic variables between the groups.
With respect to risk factors for impaired wound healing, the suture group had a significantly lower rate of renal insufficiency (5.8% vs 2.1%; P = .032, Phi = 0.09), while no significant differences were observed for diabetes, cardiovascular and vascular diseases, chronic obstructive pulmonary disease, immunosuppression, or nicotine use (Table 1).
Regarding wound healing, the suture group demonstrated a shorter mean duration of wound erythema (0.0 ± 0.2 vs 0.2 ± 1.6 days; P = .049 [95% confidence interval (CI): −0.37 to −0.001]; Cohen`s d = 0.16). Similarly, durations of serous (0.2 ± 1.9 vs 0.8 ± 2.7 days; P = .001 [95% CI: −1.00 – −0.24]; Cohen`s d = 0.26) and bloody (0.2 ± 1.0 vs 0.5 ± 2.2 days; P = .009 [95% CI: −0.65 to −0.10]; and Cohen`s d = 0.33) wound discharge were reduced. Prolonged wound secretion (≥7 days) occurred more frequently in the staple group (3.73% vs 0.69%; P = .021; Phi = 0.103), corresponding to an odds ratio of 5.54 (95% CI: 1.22-25.21).
Wounds in the suture group were classified as “bland” significantly earlier (0.4 ± 2.1 vs 1.3 ± 3.1 days; P < .001 [95% CI: −1.30 to −0.44]; Cohen`s d = 0.33), and the length of hospital stay was shorter than the staple group (6.1 ± 2.0 vs 7.0 ± 3.3 days; P < .001 [95% CI: −1.42 to −0.52] Cohen`s d = 0.35).
While there was a tendency toward higher rates of wound revision (1.4 % vs 0.3 %) and early implant revision (2.3 % vs 1.0 %) in the staple group, these differences did not reach statistical significance (Table 2).
Multivariable linear regression models were performed to adjust for potential confounders, including age, BMI, diabetes, smoking, and renal insufficiency (Table 3). After adjustment, closure type remained a significant independent predictor for all assessed outcomes. Specifically, the use of suture was associated with a significant reduction in the duration of serous discharge (B = −0.61; P = .002), bloody discharge (B = −0.39; P = .005), time until the wound was bland (B = −0.89; P < .001), and overall length of hospital stay (B = −0.90; P < .001). Furthermore, higher BMI was consistently associated with prolonged wound secretion, delayed wound healing, and longer hospital stay.
Table 3.
Multivariable linear regression analysis of factors associated with wound healing outcomes.
| Variable | Serous discharge |
Bloody discharge |
Wound bland |
Length of stay |
|---|---|---|---|---|
| B (95% CI) | B (95% CI) | B (95% CI) | B (95% CI) | |
| Closure type | ||||
| (Suture vs staple) | −0.61 (95% CI: −0.99 to 0.23); P < .002 | −0.39 (95% CI: −0.68 to −0.12); P < .005 | −0.89 (95% CI: −1.31 to −0.46); P < .001 | −0.90 (95%: −1.34 to −0.46); P < .001 |
| Age | 0.02 (95% CI: −0.002 to 0.04); P < .08 | 0.07 (95% CI: −0.07 to 0.02); P = .332 | 0.02 (95% CI: 0.03 to 0.05); P = .03 | 0.05 (95% CI: 0.03 to 0.07); P < .001 |
| BMI | 0.09 (95% CI: 0.05 to 0.13); P < .001 | 0.07 (95% CI: 0.04 to 0.10); P < .001 | 0.12 (95% CI: 0.08 to 0.17); P < .001 | 0.12 (95% CI: 0.07 to 0.16); P < .001 |
| DM1 | −0.45 (95% CI: −3.08 to 2.19); P = .74 | −0.35 (95% CI: −2.28 to 1.59); P = .73 | −0.85 (95% CI: −3.79 to 2.10); P = .573 | 0.57 (95% CI: −2.47 to 3.61); P = .71 |
| DM2 | 0.04 (95% CI: −0.61 to 0.69); P = .91 | −0.37 (95% CI: −0.85 to 0.11); P = .13 | −0.45 (95% CI: −1.18 to 0.28); P = .22 | 0.61 (95% CI: −0.14 to 1.36); P = .11 |
| Smoking | 0.26 (95% CI: −0.43 to 0.95); P = .46 | −0.02 (95% CI: −0.52 to 0.498); P = .95 | 0.20 (95% CI: −0.58 to 0.97); P = .62 | 0.39 (95% CI: −0.41 to 1.18); P = .34 |
| Renal insufficiency | 0.27 (95% CI: −0.71 to 1.26); P = .59 | −0.30 (95% CI: −1.02 to 0.43); P = .42 | −0.38 (95% CI: −1.48 to 0.72); P = .50 | 1.42 (95% CI: 0.29 to 2.55); P < .001 |
DM1, diabetes mellitus type 1; DM2, diabetes mellitus type 2.
A total of 380 patients (183 staple, 197 suture) were available for scar assessment. No significant differences were found between groups in any score category or in subjective satisfaction with the scar (Table 4).
Discussion
Our study demonstrates that subcuticular sutures after minimally invasive anterolateral THA are associated with less early wound erythema, reduced serous and bloody discharge, earlier achievement of a bland wound status, and earlier hospital discharge compared with metal staples.
While the observed effect sizes were small, the consistency across multiple endpoints supports a systematic advantage of sutures over staples. These findings are in line with previous studies indicating superior early wound healing with suture closure in hip arthroplasty [2,5,10]. In a randomized trial including 535 patients with THA staple closure was associated with increased wound drainage, a fourfold higher rate of superficial surgical site infection (4% vs 1%), and a threefold higher rate of overall wound complications (17% vs 5%) than subcuticular suture [13]. Similarly, a 2021 meta-analysis including 1286 THA patients found that sutures were associated with lower odds of superficial infection and prolonged discharge, with no differences in wound dehiscence or inflammation [5]. A 2022 systematic review showed that in hip arthroplasty, the use of staples carried 2.5 times higher risk of surgical site infection than sutures [10].
However, the mentioned studies did not account for surgical approach and included varying materials and techniques for skin closure (eg, interrupted vs continuous, absorbable vs nonabsorbable sutures). The role of the surgical approach—particularly anterior vs lateral or posterior—in relation to postoperative wound complications and infection has been discussed in the literature [[17], [18], [19]] with higher infection rates reported after anterior approach [18,19]. Data specific to the minimally invasive anterolateral approach are limited. One retrospective analysis found higher periprosthetic joint infection (PJI) rates after anterolateral THA than lateral THA in obese patients with BMI >35 kg/m2 [15], while a meta-analysis found no increased PJI rate compared with the anterior approach [20]. Both studies focused exclusively on PJI and did not assess wound healing complications [15,20].
Based on our institutional experience, staple closure in the minimally invasive anterolateral approach may predispose to persistent drainage and wound complications, particularly at proximal wound edges in obese patients with prominent abdominal fat. Therefore, some surgeons prefer skin sutures instead of staples in these patients. The biological rationale is that a continuous closure with sutures ensures more uniform skin edge apposition and a tighter seal. In contrast, the point-by-point fixation of staples may leave microgaps and provoke local irritation, which can manifest clinically as erythema and wound exudation.
Drainage is clinically relevant because persistent exudate is a risk factor for subsequent infection and reoperation, and it drives extra nursing care and surveillance. Previous studies have linked prolonged wound drainage with higher odds of PJI [[21], [22], [23]]. In particular, moderate-to-severe drainage persisting into the third postoperative week, or newly developed drainage after the second week strongly correlates with infection [23]. Accordingly, reduced risk for prolonged secretion in the suture group likely reduces the downstream risk for revision. In our cohort early implant revision rates were comparable between groups (2.3% staples vs 1.0% sutures; P = .358). Although numerical differences favored the suture group, the rarity of these outcomes suggests that the analyses were underpowered to detect small-to-moderate effects. Furthermore, the risk of revision is influenced by a variety of factors beyond wound closure, including patient-related and perioperative variables; therefore, these findings should be interpreted with caution.
Beyond the early postoperative period, long-term cosmetic outcomes did not differ between sutures and staples in our cohort. This aligns with consensus statements noting insufficient evidence for a lasting cosmetic advantage of either technique [24]. Likewise, a systematic review comparing sutures and staples after lateral or posterior THA have failed to demonstrate consistent cosmetic benefits [8]. Accordingly, the principal rationale for selecting suture closure lies in its ability to reduce early wound morbidity and potentially lower the risk of infection, rather than to enhance long-term scar aesthetics.
The shorter length of hospital stay observed in the suture group is of particular relevance in contemporary arthroplasty care, as even modest reductions in hospitalization duration may translate into substantial resource savings at a system level. Staples can shorten operative time [4,5,8,25]. But for the minimal invasive anterolateral approach—with an incision length of 7-12 cm [26], or even shorter when using special implants and instruments [27]—the time savings are likely negligible and may not translate into lower total costs. This aligns with previous findings showing that longer skin-closure times with sutures may increase surgical costs, but these are outweighed by longer hospital stays, ultimately leading to higher overall costs when using staples [4]. Overall wound complications, rather than device price or closure time, remain the main cost drivers. However, as with revision rates the length of hospital stay is influenced by multiple factors beyond wound closure; therefore, the observed difference should be interpreted cautiously.
This study has several limitations. Its retrospective, nonrandomized design may introduce selection bias, and blinding was not possible. Furthermore, numerically higher rates of comorbidities in the staple group may have biased some outcome measures, particularly length of hospital stay, despite the absence of statistically significant differences. The statistical power to detect rare complications was limited. Scar assessment was available only for a subset of the overall cohort, which may introduce selection bias and follow-up timing differed between groups which may have influenced scar assessment; however, as follow-up exceeded 12 months in both groups (19.4 vs 23.6 months), a time point at which scar maturation is generally complete, the clinical impact is likely limited. Strengths include a large sample size, uniform implant system, standardized perioperative management, daily wound assessment by specialized staff, and incorporation of scar evaluation.
Conclusions
Subcuticular suture closure was associated with reduced early wound secretion earlier achievement of a dry, unremarkable wound, as well as earlier hospital discharge after minimally invasive anterolateral THA. These findings suggest a potential clinical benefit; however, confirmation in prospective randomized studies is warranted.
Conflicts of interest
The authors declare there are no conflicts of interest.
For full disclosure statements, refer to https://doi.org/10.1016/j.artd.2026.102099.
CRediT authorship contribution statement
Thomas Stumpner: Writing – original draft, Investigation, Conceptualization. Jakob Wallner: Data curation. Martin Bischofreiter: Writing – review & editing. Michael S. Gruber: Writing – review & editing. Harald Kindermann: Formal analysis. Reinhold Ortmaier: Supervision, Conceptualization.
Appendix A. Supplementary data
References
- 1.Learmonth I.D., Young C., Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508–1519. doi: 10.1016/S0140-6736(07)60457-7. [DOI] [PubMed] [Google Scholar]
- 2.Smith T.O., Sexton D., Mann C., Donell S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ. 2010;340 doi: 10.1136/bmj.c1199. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Sadik K., Flener J., Gargiulo J., Post Z., Wurzelbacher S., Hogan A., et al. A US hospital budget impact analysis of a skin closure system compared with standard of care in hip and knee arthroplasty. Clinicoecon Outcomes Res. 2019;11:1–11. doi: 10.2147/CEOR.S181630. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Rui M., Zheng X., Sun S., Li C., Zhang X., Guo K., et al. A prospective randomised comparison of 2 skin closure techniques in primary total hip arthroplasty surgery. Hip Int. 2018;28:101–105. doi: 10.5301/hipint.5000534. [DOI] [PubMed] [Google Scholar]
- 5.Liu Z., Liu B., Yang H., Zhao L. Staples versus sutures for skin closure in hip arthroplasty: a meta-analysis and systematic review. J Orthop Surg Res. 2021;16:735. doi: 10.1186/s13018-021-02870-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Barrow J., Divecha H., Board T. Skin closure in arthroplasty surgery: current practice. Int Wound J. 2018;15:966–970. doi: 10.1111/iwj.12956. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Buttaro M.A., Quinteros M., Martorell G., Zanotti G., Comba F., Piccaluga F. Skin staples versus intradermal wound closure following primary hip arthroplasty: a prospective, randomised trial including 231 cases. Hip Int. 2015;25:563–567. doi: 10.5301/hipint.5000278. [DOI] [PubMed] [Google Scholar]
- 8.Elbardesy H., Gul R., Guerin S. Subcuticular sutures versus staples for skin closure after primary hip arthroplasty. Acta Orthop Belg. 2021;87:55–64. [PubMed] [Google Scholar]
- 9.Khan R.J.K., Fick D., Yao F., Tang K., Hurworth M., Nivbrant B., et al. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br. 2006;88-B:238–242. doi: 10.1302/0301-620X.88B2.16923. [DOI] [PubMed] [Google Scholar]
- 10.van de Kuit A., Krishnan R.J., Mallee W.H., Goedhart L.M., Lambert B., Doornberg J.N., et al. Surgical site infection after wound closure with staples versus sutures in elective knee and hip arthroplasty: a systematic review and meta-analysis. Arthroplasty. 2022;4:12. doi: 10.1186/s42836-021-00110-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Singh B., Mowbray M.A.S., Nunn G., Mearns S. Closure of hip wound, clips or subcuticular sutures: does it make a difference? Eur J Orthop Surg Traumatol. 2006;16:124–129. doi: 10.1007/s00590-005-0043-2. [DOI] [PubMed] [Google Scholar]
- 12.Lu Y., Wang C., Lin L., Qin Q., Li Q. Complication rate of different wound closures after primary hip arthroplasty - a survey of 373 patients. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2018;11:15–18. doi: 10.1016/j.asmart.2017.11.002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Mallee W.H., Wijsbek A.E., Schafroth M.U., Wolkenfelt J., Baas D.C., Vervest T.M.J.S. Wound complications after total hip arthroplasty: a prospective, randomised controlled trial comparing staples with sutures. Hip Int. 2020;35:326–331. doi: 10.1177/1120700020939075. [DOI] [PubMed] [Google Scholar]
- 14.Aggarwal V.K., Elbuluk A., Dundon J., Herrero C., Hernandez C., Vigdorchik J.M., et al. Surgical approach significantly affects the complication rates associated with total hip arthroplasty. Bone Joint J. 2019;101-B:646–651. doi: 10.1302/0301-620X.101B6.BJJ-2018-1474.R1. [DOI] [PubMed] [Google Scholar]
- 15.Luger M., De Vries M., Feldler S., Hipmair G., Gotterbarm T., Klasan A. A propensity score-matched analysis on the impact of patient and surgical factors on early periprosthetic joint infection in minimally invasive anterolateral and transgluteal total hip arthroplasty. Arch Orthop Trauma Surg. 2023;143:5405–5415. doi: 10.1007/s00402-022-04756-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Draaijers L.J., Tempelman F.R.H., Botman Y.A.M., Tuinebreijer W.E., Middelkoop E., Kreis R.W., et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113:1960–1965. doi: 10.1097/01.prs.0000122207.28773.56. discussion 1966-1967. [DOI] [PubMed] [Google Scholar]
- 17.Carlock K.D., Wilkerson J.B., Yamaguchi J.T., Fernando N.D. A comparison of wound complications following total hip arthroplasty performed through the direct anterior versus direct lateral approach. Arthroplast Today. 2024;27 doi: 10.1016/j.artd.2024.101388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Pincus D., Jenkinson R., Paterson M., Leroux T., Ravi B. Association between surgical approach and major surgical complications in patients undergoing total hip arthroplasty. JAMA. 2020;323:1070–1076. doi: 10.1001/jama.2020.0785. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Salmons H.I., Larson D.R., Couch C.G., Bingham J.S., Ledford C.K., Trousdale R.T., et al. Surgical approach and body mass index impact risk of wound complications following total hip arthroplasty. J Arthroplasty. 2024;39:S459–S463. doi: 10.1016/j.arth.2024.03.047. [DOI] [PubMed] [Google Scholar]
- 20.Acuña A.J., Do M.T., Samuel L.T., Grits D., Otero J.E., Kamath A.F. Periprosthetic joint infection rates across primary total hip arthroplasty surgical approaches: a systematic review and meta-analysis of 653,633 procedures. Arch Orthop Trauma Surg. 2021;142:2965–2977. doi: 10.1007/s00402-021-04186-3. [DOI] [PubMed] [Google Scholar]
- 21.Almeida R.P., Mokete L., Sikhauli N., Sekeitto A.R., Pietrzak J. The draining surgical wound post total hip and knee arthroplasty: what are my options? A narrative review. EFORT Open Rev. 2021;6:872–880. doi: 10.1302/2058-5241.6.200054. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Patel V.P., Walsh M., Sehgal B., Preston C., DeWal H., Di Cesare P.E. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89:33–38. doi: 10.2106/JBJS.F.00163. [DOI] [PubMed] [Google Scholar]
- 23.Scheper H., Mahdad R., Elzer B., Löwik C., Zijlstra W., Gosens T., et al. Wound drainage after arthroplasty and prediction of acute prosthetic joint infection: prospective data from a multicentre cohort study using a telemonitoring app. J Bone Jt Infect. 2023;8:59–70. doi: 10.5194/jbji-8-59-2023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Ainslie-Garcia M., Anderson L.A., Bloch B.V., Board T.N., Chen A.F., Craigie S., et al. International Delphi Study on wound closure and incision management in joint arthroplasty part 2: total hip arthroplasty. J Arthroplasty. 2024;39:1524–1529. doi: 10.1016/j.arth.2024.01.047. [DOI] [PubMed] [Google Scholar]
- 25.Krishnan R.J., Crawford E.J., Syed I., Kim P., Rampersaud Y.R., Martin J. Is the risk of infection lower with sutures than with staples for skin closure after orthopaedic surgery? A meta-analysis of randomized trials. Clin Orthop Relat Res. 2019;477:922–937. doi: 10.1097/CORR.0000000000000690. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Pflüger G., Junk-Jantsch S., Schöll V. Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop. 2007;31:S7–S11. doi: 10.1007/s00264-007-0434-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Berger R.A. Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am. 2004;35:143–151. doi: 10.1016/S0030-5898(03)00111-1. [DOI] [PubMed] [Google Scholar]
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