Usage of CA as an Adjunct Shown To Have “Statistically Significant” Results

The Use of 2-Octyl Cyanoacrylate (CA) as an Adjunct to Wound Closure After Total Knee Arthroplasty (TKA)

Yaser El-Gazzar, MD, New York New York, United States as reported in the American Academy of Orthopedic Surgeons in the 2012 Annual Meeting.

INTRODUCTION. Wound drainage after total knee arthroplasty (TKA) is a complication that can be detrimental to surgical outcome. Post-operative course may be negatively affected resulting in increased hospital length stay, patient dissatisfaction, discontinued deep venous thrombosis (DVT) chemoprophylaxis, delayed mobility, increased risk of infection, and/or delayed epithelization of surgical wound.

The purpose of this study was to examine the usage of 2-octyl cyanoacrylate (CA) as an adjunct to wound closure after TKA. We proposed that the addition of CA will result in a significant decrease in wound drainage after TKA.

METHODS. This is an IRB approved, prospective, randomized, controlled trial. Forty-four patients undergoing 44 primary total knee arthroplasties were enrolled. Exclusion criteria included: history of previous surgery, infection, or trauma to the operative knee; history of hypocoaguable/hypercoaguable states; need for therapeutic DVT/pulmonary embolism (PE) treatment pre- or post- surgery; and any co-morbidity that may delay wound healing (e.g. ESRD). Each patient received a standardized closure following TKA. After skin staples were placed, each patient was then randomized into the experimental or control groups. The experimental group received CA as a supplement to the closure. The standardized gauze dressing placed were evaluated on post-op days two and three. Through the use of volumetric analysis, the drainage units from both groups were compared utilizing a Mann-Whitney U Test.

RESULTS. The mean total drainage for the control and experimental groups over the course of three days post-op were 657 and 153 respectively (p<.001). The decrease in drainage was statistically significant post-op days two and three as well as the combined total.

DISCUSSION AND CONCLUSION. The use of CA as an adjunct to wound closure in TKA results in a statistically significant decrease in wound drainage in the immediate post-operative period.