Randomized Controlled Trial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2019; 10(7): 268-277
Published online Jul 18, 2019. doi: 10.5312/wjo.v10.i7.268
Randomised controlled trial of triclosan coated vs uncoated sutures in primary hip and knee arthroplasty
Mohamed Sukeik, David George, Ayman Gabr, Rami Kallala, Peter Wilson, Fares Sami Haddad
Mohamed Sukeik, David George, Ayman Gabr, Rami Kallala, Fares Sami Haddad, Department of Trauma and Orthopaedics, University College London Hospital, London NW1 2BU, United Kingdom
Mohamed Sukeik, Department of Trauma and Orthopaedics, Dr. Sulaiman Al-Habib Hospital – Al Khobar, King Salman Bin Abdulaziz Rd, Al Bandariyah, Al Khobar 34423, Saudi Arabia
Peter Wilson, Department of Clinical Microbiology, UCLH, London NW1 2PG, United Kingdom
Author contributions: Sukeik M, George D, Gabr A, Kallala R, Wilson P and Haddad FS contributed equally to this paper with conception and design of the study, literature review and analysis, drafting, critical revision and editing, and approval of the final version.
Institutional review board statement: The study has local R&D approval to proceed and recruit participants and the approval is granted on the basis of the key documents provided which are ethically approved by the Research Ethics Committee.
Clinical trial registration statement: A favourable ethical opinion has been granted for the research study on the basis described in the application form, protocol and supporting documentation as revised.
Informed consent statement: Patients agreed to take part in the study after reading the detailed consent form.
Conflict-of-interest statement: No potential conflicts of interest to declare. No external financial support.
Data sharing statement: Following the study, there will be access to raw data and right to publication freely by all investigators in the study. The study results will also be presented at various national and international meetings.
CONSORT 2010 statement: The manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohamed Sukeik, MD (Hons), FRCSEd (Tr&Orth), PGA, MD (Res), Consultant Hip and Knee Surgeon, Dr. Sulaiman Al-Habib Hospital – Al Khobar, King Salman Bin Abdulaziz Rd, Al Bandariyah, Al Khobar 34423, Saudi Arabia. m.sukeik@nhs.net
Telephone: +966-138711111
Received: April 6, 2019
Peer-review started: April 8, 2019
First decision: June 12, 2019
Revised: June 29, 2019
Accepted: July 8, 2019
Article in press: July 8, 2019
Published online: July 18, 2019
ARTICLE HIGHLIGHTS
Research background

Despite the lack of evidence that using triclosan-coated sutures has any benefits in hip and knee arthroplasty surgery, they have been used widely due to the potential benefit of improving wound healing and reducing surgical site infections.

Research motivation

We sought to compare the wound healing characteristics and wound complications associated with the use of triclosan-coated sutures and compared them to non-coated sutures in primary hip and knee arthroplasty surgery.

Research objectives

Our main objective was to investigate the potential benefits of using triclosan-coated sutures in hip and knee arthroplasty surgery using a well designed randomised controlled trial to guide future practice.

Research methods

A single-centred double blinded randomised controlled trial was conducted according to strict inclusion and exclusion criteria and following the Research and Development and Regional Ethics Committee guidelines for conducting high-quality well-designed trials with the above objectives. Primary and secondary outcomes were defined, computer randomisation was performed through Sealed Envelope and statistical analysis including power calculation was planned and approved prior to conducting the trial.

Research results

Utilising the ASEPSIS scoring system, there were no significant differences between the triclosan-coated and non-coated sutures. However, wound complications were noted more frequently at the 2 and 6 wk follow up in the triclosan-coated sutures group. As the study has been terminated earlier than planned due to the unavailability of the sutures, further randomised controlled trials are still warranted to fully answer the question of whether triclosan-coated sutures provide any protection against wound complications and infections after hip and knee arthroplasty surgeries.

Research conclusions and perspectives

The current literature supports the use of triclosan-coated sutures in some disciplines of general surgery but the evidence in orthopaedic surgery especially in arthroplasty procedures remains inconclusive. This trial supports the findings from other studies that triclosan-coated sutures do not provide any benefits over non-coated sutures in protecting against wound complications and infections after hip and knee arthroplasty surgery. Therefore, we recommend against the routine use of those sutures and advise that efforts should continue to emphasise the benefits of preventative measures against infections and explore new modalities of reducing surgical site infections. The utilisation of a well-designed randomised controlled trial will help in answering whether any of those new modalities will stand the challenge of time and optimal outcomes.