Shortcomings of surgical staples for wound closure after total knee arthroplasty (TKA) include pain, ugly scars, and wound-related complications. A new non-invasive wound-closure device, Zip Surgical Skin Closure (the Zip device), has statistically significant benefits in clinical outcomes and patient satisfaction compared to surgical staples, according to a study conducted by Shelbourne Knee Center orthopedic surgeon Rodney Benner, MD.
The Zip uses adhesive strips on the skin on either side of the wound, after placement of deeper supporting suture layers, and zip ties traversing the wound linked in a zigzag pattern between adjacent rows. The device provides uniform wound closure and protects the incision area from pulling or tugging caused by patient movement. By gently compressing the incision during extension, the Zip device ensures secure wound closure for healing.
Randomized Controlled Trial Compares the Zip and Staples
Dr. Benner and Jonathan P. Behrens, MD, a resident at St. Louis University Hospital, studied the Zip device in a randomized, controlled, prospective trial with 25 patients undergoing same-day bilateral TKA. Patients were randomized to receive skin closure with the Zip device on one knee and staples on the other. At the time of surgery, the mean age of the participants—12 female and 13 male—was 66.4 years. Dr. Benner performed all Zip device and staple applications.
Results Show Less Pain and Scaring and Better Function
“Patients reported less pain, improved cosmetic outcomes, and even improved early function by improving range of motion on the Zip device knee,” say Dr. Benner. He and Dr. Behrens reported the study results in the Journal of Knee Surgery(1).
A scale of 0 (best) to 10 (worst) was used to rate patients’ pain and scar appearance and a physical therapist measured knee arc of motion. Patients reported much less pain on the Zip device knee compared to the stapled knee during the two weeks they wore the device (p = 0.03) and at device removal (p = 0.003).
Patients, an orthopedic surgeon and a plastic surgeon rated the scar appearance at eight weeks postoperatively. Ratings for the Zip device knee versus the stapled knee were higher for:
- 60% of patient ratings
- 88% of orthopedic surgeon ratings
- 77% of plastic surgeon ratings
When the device was removed, 92% of patients preferred the Zip device over staples. At the 8-week follow-up visit, 84% of patients preferred the Zip device.
Range of motion (ROM) was better at two weeks postoperatively for 18 of 25 patients, providing better function early. Final ROM at eight weeks postoperatively was the same for both knees.
“The Zip closure improved the patient experience, and as a result, I have changed my practice to include Zip closure in all knee arthroplasties,” says Dr. Benner. He has extensive experience in primary and revision TKA surgery and completed a fellowship in knee surgery, sports medicine and knee replacement at Insall Scott Kelly Institute.
Other Research on the Zip Device
Dr. Benner’s study was the first randomized controlled trial to compare TKA outcomes for the Zip device and staples. Previous studies found quicker surgical closure time(2), better scar appearance(3) and a statistically significant lower rate of wound-related complications with the Zip device compared with staples(2).
A health economics study used retrospective chart review and case study to compare 65 TKA patients who received staples and 65 patients who received the Zip device. Researchers found that compared to patients receiving the Zip device, those receiving staples made more incision-related phone calls to the clinic. The number of additional calls was statistically significant. Staples patients also had more incision-related ER admits and clinic visits, and received more antibiotic prescriptions, however, the differences were not statistically significant.
For more information about TKA at Shelbourne Knee Center, call 888-FIX-KNEE.
References
- Benner RW, Behrens JP. A Novel Skin Closure Device for Total Knee Arthroplasty: Randomized Controlled Trial versus Staples. J Knee Surg. 2019 Jul 9. doi: 10.1055/s-0039-1692628.
- Carli AV, Spiro S, Barlow BT, Haas SB. Using a non-invasive secure skin closure following total knee arthroplasty leads to fewer wound complications and no patient home care visits compared to surgical staples. Knee. 2017;24(05):1221–1226.
- Ko JH, Yang IH, Ko MS, Kamolhuja E, Park KK. Do zip-type skin-closing devices show better wound status compared to conventional staple devices in total knee arthroplasty? Int Wound J. 2017;14(01):250–254.
- Alnachoukati O, Emerson R, Muraguri M. Non-invasive, Zip Type Skin Closure Device vs. Conventional Staples in Total Knee Arthroplasty: Which Method Holds Greater Potential for Bundled Payments? Cureus. March 2019.