The effect of suturing techniques on aberrant wound recovery after total hip arthroplasty

Aims: The Netherlands is expected to see an increase in the annual number of primary total hip arthroplasties (THAs), as is the expectation in England, Wales, and Northern Ireland, according to the National Joint Registry (NJR). In 2023, the mean age for a patient receiving a primary THA was 69.3 years (SD 11.8) in the Netherlands, while the NJR documented a median age of 69 years. Wound recovery is impaired in elderly patients, and poor wound recovery could result in invasive and costly revision surgery. Currently, there is no consensus in the orthopaedic literature on which closure method is superior to prevent abnormal wound recovery. Methods: This prospective randomized trial will compare the effect of Monocryl, Vicryl Rapide with Indermil skin glue, Dermabond Prineo, and Stryker Zip on the amount of aberrant wound recovery within 14 days after primary THA via the direct anterior approach (DAA). Secondary outcomes include occurrence of superficial and deep wound infections within 90 days postoperatively, costs of the suturing techniques, number of visits to a healthcare professional for wound-related causes, and patient satisfaction scores. Photographs of the plaster (day three and day 11) and of the surgical wound (day seven and day 14) will be assessed with a self-developed classification model. Patient outcomes will be measured by a questionnaire at 14 and 90 days postoperatively. Discussion: This study will contribute to improving clinical care for patients undergoing DAA THA. Aberrant wound recovery was chosen as a proxy for periprosthetic joint infection since PJI as primary outcome measure would require an unfeasible number of patients for a prospective single-centre study. The classification model used is both a strength and a weakness. It has been developed specifically for this study, but its use has not yet been validated. Due to the nature of this study, full blinding is not possible. Only the assessors are partially blinded.