JOA - 2026-07-22 - Journal Article
Reduced Wound Complications with Absorbable Deep Dermal Staples in Direct Anterior Total Hip Arthroplasty.
Abuoqab L, Rice SW, Crawford DA
Topics
Key Takeaway
Absorbable intradermal staples reduced wound complication rates from 8.1% to 2.8% compared to barbed sutures in DAA THA, though obese patients remained at elevated risk in both groups.
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Summary
This single-surgeon retrospective study compared wound complication rates between absorbable intradermal staples (n=357) and barbed sutures (n=346) for deep dermal closure in consecutive primary DAA THA. The stapler group had a significantly lower wound complication rate (2.8% vs 8.1%, P<0.002), though return-to-OR rates did not differ significantly. In both groups, patients with wound complications had significantly higher BMIs (stapler group: 40.4 vs 31.0 kg/m², P<0.001; control group: 38.2 vs 31.8 kg/m², P<0.001).
Key Limitation
The stapler group was significantly older with higher BMI than the barbed suture group, and the absence of multivariate regression controlling for these confounders means the observed complication rate reduction cannot be definitively attributed to closure technique alone.
Original Abstract
BACKGROUND
The direct anterior approach (DAA) for total hip arthroplasty (THA) has been increasingly adopted for its muscle-sparing nature. However, wound complications remain a well-documented limitation in DAA cohorts. We evaluated the efficacy of absorbable staple augmentation as an alternative to conventional barbed sutures for incision closure in DAA THA. We hypothesized that absorbable staple augmentation would be associated with reduced incidence of wound complications, particularly in patients who have elevated body mass index (BMI).
METHODS
A retrospective review was performed on 703 consecutive primary DAA cases conducted by a single surgeon. Patients were divided into two groups: absorbable intradermal staples (n = 357) and barbed sutures (n = 346). Demographics, wound complications, and return to the operating room for wound issues were recorded. Statistical analyses included unpaired t-tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. Baseline demographics were similar, though the stapler group was significantly older (P < 0.001) and had a higher body mass index (P < 0.002).
RESULTS
The stapler group demonstrated a significantly lower wound complication rate (2.8 versus 8.1%, P < 0.002). Rates of return to the operating room for wound complications were not significantly different between groups. Across both groups, patients who had wound complications had higher BMIs (control: 38.2 versus 31.8, P < 0.001; stapler: 40.4 versus 31.0 kg/m 2 , P < 0.001). Patients who had complications tended to be younger, with no difference in sex.
CONCLUSION
Absorbable staple augmentation was associated with significantly fewer complications compared to barbed sutures alone, though obese patients remained at higher risk. Potential mechanisms for improved outcomes may include its longer time to dissolve, precise edge apposition, and clearance of the epidermis, contributing to uniform tension distribution and robust wound healing. Absorbable staple augmentation may provide a practical closure method for prospective studies.