Skin Staples vs Subcuticular Suturing Method for Wound Closure After Knee Arthroplasty: Comparison of Cosmetic Outcomes and Patient Satisfaction

Abstract

Background: Osteoarthritis is a major cause of disability worldwide, and total knee arthroplasty (TKA) remains the definitive surgical treatment for end-stage disease. While various wound closure techniques are employed following TKA, there remains ongoing debate regarding whether skin staples or subcuticular suturing yields better clinical and cosmetic outcomes. Understanding the effect of closure method on patient-centered outcomes, including wound appearance, satisfaction, and functional recovery, is critical for optimizing postoperative care. Objective: To compare wound healing quality, cosmetic outcomes, functional recovery, and patient satisfaction between skin staples and subcuticular suturing techniques following primary TKA. Methods: This retrospective comparative study was conducted at Shifa International Hospital, Islamabad, Pakistan, and included 120 patients undergoing primary unilateral TKA. Patients were grouped based on closure technique: staples (Group A) and subcuticular sutures (Group B). Wound healing was evaluated using the Hollander Wound Evaluation Scale (HWES), cosmetic appearance and satisfaction by visual analogue scales (VAS), and functional recovery by the American Knee Society Score (AKSS) at 6 weeks and 3 months postoperatively. Data were analyzed using SPSS 22.0, applying t-tests and chi-square tests with a significance threshold of p ≤ 0.05. Results: Baseline characteristics were comparable between groups (p > 0.05). At 6 weeks, the suture group showed higher cosmesis (7.88 ± 0.88 vs. 5.66 ± 1.03, p < 0.001) and satisfaction (7.71 ± 0.95 vs. 6.18 ± 0.96, p < 0.001). By 3 months, subcuticular suturing yielded significantly higher HWES (5.66 ± 0.47 vs. 5.06 ± 0.63, p < 0.001), cosmesis (8.68 ± 0.62 vs. 6.66 ± 0.60, p < 0.001), AKSS (88.15 ± 1.84 vs. 84.08 ± 3.12, p < 0.001), and satisfaction (8.86 ± 0.59 vs. 7.51 ± 0.53, p < 0.001). No wound complications occurred in either group. Conclusion: Subcuticular suturing provides superior wound healing, cosmetic results, functional recovery, and patient satisfaction compared with staples following TKA, without compromising safety. Its adoption in routine arthroplasty practice can enhance patient-centered outcomes and overall postoperative quality of care.