Evidence-Based Orthopaedics   |    
Skin Adhesive or Staples Were Not Different for Skin Closure After Total Hip Replacement

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Source of funding: MedLogic.
For correspondence: Ms. C. Livesey, Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, UK. E-mail address: c.livesey@bristol.ac.uk
Disclosure: The author did not receive any outside funding or grants in support of his research for or preparation of this work. The author, or a member of his immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy Inc.).

Livesey  C,  Wylde  V,  Descamps  S,  Estela  CM,  Bannister  GC,  Learmonth  ID,  Blom  AW. Skin Closure After Total Hip Replacement: A Randomised Controlled Trial of Skin Adhesive versus Surgical Staples. J Bone Joint Surg Br.2009Jun;91:725-9.

J Bone Joint Surg Am, 2010 Feb 01;92(2):476-476. doi: 10.2106/JBJS.9202.ebo890
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In patients undergoing primary total hip replacement, how does skin closure with skin adhesive compare with staples for cosmetic appearance of the scar?
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Jay R. Lieberman, MD
    Posted on May 25, 2010
    Dr. Lieberman responds to Mr. Thavarajah
    Department of Orthopedic Surgery, University of Connecticut Health Center, Hartford, Connecticut

    I appreciate the interest in my review. First, although the study was funded by the company, the conflict was disclosed. The study was well designed and the reader will have to decide if the conflict had a negative impact on the study. Second, in my review I did not state that the results should induce a change in practice but this technology does deserve further study.

    Dushan Thavarajah
    Posted on April 16, 2010
    Confounding Issues
    Milton Keynes General Hospital, Milton Keynes, United Kingdom

    To the Editor:

    I read the commentary by Lieberman (1) with interest which describes the comparison of steri strips (adhesive) versus clips, using plastic surgeons, orthopaedic surgeons and the patients as scorers for the cosmetic result. The conclusion is that the cosmetic appearance of the scar did not differ with adhesive or clips.

    The are 2 points that I would like to raise:

    1. The study was funded by MedLogic, who manufactures the steristrips. Therefore this is a significant confounding factor which may favor the adhesive due the financial incentive received.

    2. The results are not statistically significant to suggest a change in practice. P-values are all greater than 0.05.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.


    1. Lieberman J. Skin adhesive or staples were not different for skin closure after total hip replacement. J Bone Joint Surg Am. 2010;92:476.

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