In this study we randomised 140 patients who
were due to undergo primary total knee arthroplasty (TKA) to have the
procedure performed using either patient-specific cutting guides
(PSCG) or conventional instrumentation (CI). The primary outcome measure was the mechanical axis, as measured
at three months on a standing long-leg radiograph by the hip–knee–ankle
(HKA) angle. This was undertaken by an independent observer who
was blinded to the instrumentation. Secondary outcome measures were
component positioning, operating time, Knee Society and Oxford knee
scores, blood loss and length of hospital stay. A total of 126 patients (67 in the CI group and 59 in the PSCG
group) had complete clinical and radiological data. There were 88
females and 52 males with a mean age of 69.3 years (47 to 84) and
a mean BMI of 28.6 kg/m2 (20.2 to 40.8). The mean HKA
angle was 178.9° (172.5 to 183.4) in the CI group and 178.2° (172.4
to 183.4) in the PSCG group (p = 0.34). Outliers were identified
in 22 of 67 knees (32.8%) in the CI group and 19 of 59 knees (32.2%)
in the PSCG group (p = 0.99). There was no significant difference
in the clinical results (p = 0.95 and 0.59, respectively). Operating time,
blood loss and length of hospital stay were not significantly reduced
(p = 0.09, 0.58 and 0.50, respectively) when using PSCG. The use of PSCG in primary TKA did not reduce the proportion
of outliers as measured by post-operative coronal alignment. Cite this article:
We undertook a randomised controlled trial to compare the outcomes of skin adhesive and staples for skin closure in total hip replacement. The primary outcome was the cosmetic appearance of the scar at three months using a surgeon-rated visual analogue scale. In all, 90 patients were randomised to skin closure using either skin adhesive (n = 45) or staples (n = 45). Data on demographics, surgical details, infection and oozing were collected during the in-patient stay. Further data on complications, patient satisfaction and evaluation of cosmesis were collected at three-month follow-up, and a photograph of the scar was taken. An orthopaedic and a plastic surgeon independently evaluated the cosmetic appearance of the scars from the photographs. No significant difference was found between groups in the cosmetic appearance of scars at three months (p = 0.172), the occurrence of complications (p = 0.3), or patient satisfaction (p = 0.42). Staples were quicker and easier to use than skin adhesive and also less expensive. Skin adhesive and surgical staples are both effective skin closure methods in total hip replacement.
