The aim of the study is to compare incision closure techniques for total knee replacement using a combination of state-of-the-art sutures with tissue adhesives or staples in an effort to identify the best approach with respect to time efficiency, cost, durability, dehiscence, microbial resistance and cosmesis.

The hypothesis is that the combined suture/adhesive approach (sutures for capsule and subcutaneous layers, and tissue adhesive for the final cutaneous layer) or suture/staple approach will be significantly faster and of comparable durability as the conventional exclusive suture approach (sutures used for the capsule, subcutaneous, and cutaneous layers). This is a prospective, randomized, controlled, single site, unblinded (open label) study.

Inclusion Criteria:

• Inclusion criteria included 18 years or older
• TKA scheduled without a bilateral planned within one week of the initial surgery
• Willingness to attend prescribed physical therapy 3 times per week.

Exclusion Criteria:

• Exclusion criteria included medical conditions or personal circumstances that would prevent participation and completion of physical therapy and follow-up visits
• Current participation in another clinical trial
• Preoperative systemic infections
• Uncontrolled diabetes, or diseases or conditions known to effect the wound healing process
• Known hypersensitivity to cyanoacrylate
• Formaldehyde, or the dye D&C Violet #2
• Prior knee hardware fixation devices
• Prior knee incisions greater than 9cm, and arthrofibrosis as evidence by limited ROM less than 80°.