Impact of Knot Tying on Surgical Glove Integrity in Arthroplasty and Arthroscopy

Overview

This study investigated the effect of intraoperative knot tying on the integrity of surgical gloves during total hip arthroplasty, total knee arthroplasty, and arthroscopic rotator cuff repair. Findings revealed that knot tying causes glove damage varying in size and location depending on the joint and surgical procedure, potentially increasing infection risk.

Background

Surgical gloves are critical in preventing infections during orthopedic procedures, but their integrity can be compromised by mechanical stresses such as knot tying. Previous studies have documented glove damage in both major surgeries like arthroplasty and less demanding procedures like arthroscopy, but the specific impact of knot tying has not been systematically studied intraoperatively. Current glove standards focus on production quality rather than mechanical stresses encountered during surgery, leaving a gap in understanding glove damage mechanisms and implications for patient and surgeon safety.

Data Highlights

Key Findings

• Knot tying during surgery causes measurable damage to surgical gloves, with differences in size and localization depending on the joint operated on.
• Major orthopedic surgeries (hip and knee arthroplasty) tend to produce larger glove lesions due to mechanical stress and instrument use compared to arthroscopic shoulder surgery.
• Glove damage in arthroscopic rotator cuff repair is generally smaller (microlesions <1 mm) but still present after multiple knot tying steps.
• Glove integrity testing using the water tightening test (EN 455) revealed that intraoperative mechanical stresses are not accounted for in current glove standards.
• Separate gloves worn exclusively for knot tying allowed isolation of damage caused specifically by this surgical step.
• Microscopic evaluation distinguished between penetrating and friction lesions, highlighting different damage mechanisms related to knot tying.

Clinical Implications

Surgeons should be aware that knot tying can compromise glove integrity, potentially increasing infection risk for both patients and surgical teams. Consideration of glove damage susceptibility by joint and procedure type may guide glove use protocols, including changing gloves after knot tying or using more resistant glove materials. Current glove standards do not reflect intraoperative mechanical stresses, underscoring the need for improved testing and protective strategies.

Conclusion

Intraoperative knot tying significantly affects surgical glove integrity, with variations by joint and procedure type. Recognizing and mitigating this damage is essential to enhance infection prevention and surgical safety.

References

1. EN 455, ASTM D3577 -- Medical Glove Standards
2. Study on Glove Damage in Arthroplasty and Arthroscopy, 2020
3. Biomechanics and Implant Technology Research Laboratory, Orthopaedic Clinic