ZipLine Medical, Inc., headquartered in Campbell, California, has announced results from the first study to assess Zip Surgical Skin Closure versus surgical staples for closure in the same patients.
Zip vs. Staples: New Closure Study Released

The results of the randomized, controlled, prospective study were presented as a poster at the American Academy of Hip and Knee Surgery Annual Meeting (AAHKS) by Rodney Benner, M.D., of the Shelbourne Knee Center in Indianapolis.
“Zip closure in knee replacement provided some clear benefits in our study,” said Dr. Benner in the November 3, 2017 news release. “Patients reported less pain, improved cosmetic outcomes, and even improved early function by improving range of motion. All in all, Zip closure improved the patient experience, and consequently, I have changed my practice to include Zip closure in all knee arthroplasties.”
The study involved 25 patients who had simultaneous bilateral total knee arthroplasty (TKA), with Zip Surgical Skin Closure used to close one knee and surgical staples to close the other on each patient.
Dr. Benner told OTW, “Certain patients were very nervous about the staples. They were concerned about having metal in their skin and were scared of the pain that accompanied staple removal. As such, an alternative that did not puncture the skin and could provide improved comfort without staple removal was attractive.”
“The design was a randomized controlled trial during bilateral total knee arthroplasties with one knee receiving standard staple closure and the other receiving the Zip closure. We then queried patients at two weeks and two months after surgery about pain, comfort, cosmetic outcome, and their side-to-side preference. I, as the operating surgeon, also evaluated their cosmetic outcome, as did a team of independent plastic surgeons.”
“The patients reported improved pain scores at all time points, both for device wear and at device removal, for the Zip knee versus the staple knee. Furthermore, measured range of motion was improved in the Zip knee. Finally, the patients, operating surgeon, and independent wound expert surgeons all rated the cosmetic outcome of the Zip knees to be superior to the staple knees.”
“Following completion of data analysis for this study, I now utilize Zip closure on all primary and revision total knee arthroplasties. The vast majority of orthopaedic surgeons performing total knee arthroplasties utilize staple closure. Our study results highlight several specific advantages to the standard staple closure with the Zip. As with any device that the surgeon has not used before, there will undoubtedly be trepidation with a novel method. With this study, I believe we can answer many of those questions that surgeons may have and allow them to improve their practices in a small way.”

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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