Achieving proper skin closure after total knee arthroplasty (TKA) is crucial for minimizing complications, as the surrounding skin is under significant tension during the early postoperative period. Cyanoacrylate, or skin adhesive, supplements subcuticular suture closure, providing a secure, watertight seal while lowering infection risk. This study compared wound healing, complications, and patient-reported outcomes between suture closure and suture plus adhesive. A total of 167 patients undergoing primary TKA were enrolled in a prospective single-blinded protocol change study at a single institution from August 2023 to September 2024. Patients had their wound closed with subcuticular 3-0 Monocryl suture (n = 69) or suture plus cyanoacrylate adhesive (S + C) (n = 98), alternating techniques every 3 months. Scar healing was assessed through photographic review at 1 month, evaluating scabbing and scar length. Wound complications, stiffness, and readmission rates were recorded. Patient satisfaction was measured at 6 months using the Patient and Observer Scar Assessment Scale (POSAS) score. Bivariate analyses evaluated differences between groups. Wound complications occurred at a similar rate between suture (11.6%) and S + C (14.3%; p = 0.784). Stiffness was reported in 6.6% of patients (8.7% suture vs. 5.1% S + C; p = 0.365). A 90-day readmission occurred in 3.6% (4.4% suture vs. 3.1% S + C; p = 0.692). Scar healing assessments showed 19.1% of patients had more than two scabs, with a higher frequency in S + C (24.2%) than sutures (12.5%; p = 0.193). The mean scar length was slightly longer in S + C (15.0 vs. 14.5 cm; p = 0.148). No cosmetic differences were noted between groups according to the mean POSAS score (5.0 ± 4.18 sutures vs. 5.1 ± 5.57 S + C; p = 0.641). Both sutures and cyanoacrylate adhesive demonstrated comparable clinical and patient-reported outcomes following TKA. The cyanoacrylate adhesive group had a slightly higher rate of minor wound healing concerns. Both closure methods are viable options, and the choice of technique can be left to the surgeon.
Furey et al. (2026) studied this question.