Two of my patients bumped into each other at a physical therapy visit. Same operation, same week, same surgeon. One looked down at a clean line of surgical glue over their healing incision. The other looked down at a row of metal staples and spent the whole drive home wondering what had gone wrong with his knee.
Nothing had gone wrong. But I understand the genuine concern, and I have been answering some version of that question for more than twenty years.
The staples vs glue conversation is really about the last few millimeters of your operation: your skin. Below is how I close almost every hip and knee replacement I perform, what that waterproof dressing buys you, when staples or a visible stitch is the better call, and why a row of staples says nothing bad about the surgery underneath it.
How Your Joint Replacement Incision Is Actually Closed
Before we get to staples vs glue, it helps to know what is already holding your incision together. When a patient asks how many stitches they got, my honest answer is that all of them are under the skin. You will not see a single one.
The layers nobody sees
Closing an incision is not one step. It is a sequence, and each layer has a job.
The deep layer goes first: the fascia and muscle that had to be moved aside to reach the joint. Then the fatty layer just beneath the skin. Then a running stitch that travels along the underside of the skin surface, pulling the edges together from below so nothing shows on top.
Every one of those stitches dissolves on its own. There is nothing to pull out later.
Dermabond, or what I call Krazy Glue for skin
Once the skin edges are lined up, I seal the surface with a surgical adhesive called Dermabond. It is a cyanoacrylate, the same chemical family as the superglue in your kitchen drawer, sterilized for use on human tissue.
The glue does two things. It holds the top layer of skin in place, and it forms a thin barrier over the line while deeper healing happens underneath.
What the Waterproof Dressing Buys You
A dry, waterproof dressing goes on while you are still in the operating room. That one detail changes your first two weeks more than almost anything else I do at the end of a case.
You can shower on day one
Water running over the dressing is fine. Not a sponge bath, not a plastic bag taped around your leg. An actual shower.
That matters more than it sounds like it should. Patients who can wash their hair the day after surgery feel like themselves again faster, and that is not a small part of recovery.
The dressing stays put until your two-week visit. When it comes off, most people still have leftover glue on the skin. That residue is normal, and it flakes away over the following weeks. You keep showering the entire time.
The one rule: no soaking
No bathtub. No swimming pool. No hot tub. Not until the incision is completely healed, which is usually three to four weeks out.
A shower runs water across the incision and it drains away. Soaking parks bacteria against a line that has not finished sealing. That difference is the whole reason for the rule.
This matches the guidance on the AAOS OrthoInfo recovery page, which notes that most modern surgical dressings are waterproof and shower-safe, and that patients should follow their own surgeon’s timing.
When Staples or a Visible Stitch Make Sense
Sometimes the top layer needs something other than glue, and the staples vs glue decision goes the other way.
If a patient has had a surgical infection before, or has a history of wounds that heal slowly, I may put a nylon suture on the surface instead. Occasionally I use staples. Both do the same job the glue would have done, and both have to come out later.
What pushes me toward staples is skin under tension, previous scarring across the same area, or a history that raises the odds of a wound problem. Diabetes, long-term steroid use, and smoking belong on that list.
I want to be honest about the tradeoffs. Staples can pinch a little on the way out. They require a removal visit, usually at about 7 to 10 days. And if they stay in too long, they leave marks. Taken out on schedule, they heal to a thin line like anything else.
Staples vs Glue: What the Research Actually Shows
I want to separate what I prefer from what the evidence supports.
Speed, drainage, and comfort
The most useful study I point patients to is a blinded randomized trial that compared three closures across 102 hip replacements and 85 knee replacements: skin glue, a subcuticular suture, and staples.
Staples were significantly faster to place. Glue produced less wound drainage in the first 24 hours for both hips and knees. For hip replacements, there was no significant difference between the three groups in early or late complications.
The time gap is real but small. In the arthroplasty literature, adhesive skin closure has been clocked at roughly 100 seconds compared with about 30 seconds for staples. A minute of operating time is not a reason to choose one method over another.
Broader reviews of skin closure have also reported less post-operative discomfort and better cosmetic scores at one month with adhesive, alongside the practical advantage of having nothing to remove.
Why staples vs glue is not a quality ranking
Read those results carefully and notice what they do not say. They do not say staples are unsafe. They do not say glue prevents infection. They describe modest differences in drainage, comfort, and appearance between three reasonable options.
That gap between “modest difference” and “better surgeon” is where a lot of internet anxiety lives. Closure is the last five minutes of a two-hour operation. Implant position, soft tissue balance, and infection prevention decided your outcome long before anyone reached for glue or a stapler.
Are Staples Barbaric? Not Fair, and Not True
Somewhere along the way staples picked up a reputation. I read the comment sections. People call them medieval, barbaric, a sign that a surgeon is behind the times.
That is not fair to the surgeons, and it is not fair to the patient reading it at two in the morning with a stapled knee propped on a pillow.
If your surgeon used staples, it does not mean you got a lesser operation. In the staples vs glue call, it almost always means someone looked at your skin, your history, and the tension across your incision, and decided in your favor. That is exactly what you want a surgeon doing.
Skin Glue Is Not Bone Cement
Everything above is about closing skin. Bone cement, which patients also call glue, is a completely different material used deep inside the joint to lock the implant to prepared bone. Different chemistry, different purpose, different question.
If someone told you your knee was glued in, they were almost certainly talking about cement, not Dermabond.
When to Call Your Surgery Team
Whatever closed your skin, the warning signs are identical. Call the office if your incision:
- Opens or separates anywhere along the line
- Starts draining, especially if drainage restarts after it had stopped
- Becomes more red over time instead of less, or the redness spreads outward
- Develops increasing pain, warmth, or a foul smell
- Is accompanied by a fever
None of those are wait-and-see problems. Redness that shrinks day by day is healing. Redness that expands is a phone call. If you cannot tell which one you are looking at, photograph it in the same light each morning and compare, then call us. General wound care principles are covered well by Cleveland Clinic, but your surgeon’s instructions always come first.
Early wound problems are far easier to manage than late ones. We would rather hear from you on a Saturday than a Tuesday. More detail is in my article on infection after joint replacement.
What Staples vs Glue Means for Your Recovery
If you are heading into a hip replacement or knee replacement, ask your surgeon two questions at your pre-op visit: how will you close my skin, and when can I shower. The answers shape your first two weeks more than most patients expect.
If you already had surgery and you are staring at staples, take a breath. Get them out on time, keep the line clean and dry, skip the bathtub, and watch for the warning signs above. Your knee replacement scar or hip replacement scar will spend the next year fading regardless of which method held it closed.
Patients at the Bone and Joint Institute of Tennessee in Franklin can reach my team at (615) 791-2630 with any incision question during recovery. We would much rather answer a question that turns out to be nothing.
Watch: Staples vs Glue Explained in 4 Minutes
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This content reflects Dr. Calendine’s independent clinical perspective and is not a substitute for advice from your own orthopedic surgeon. Individual healing timelines vary based on your health history, your skin, and the specifics of your procedure.
References
- Khan RJK, Fick D, Yao F, Tang K, Hurworth M, Nivbrant B, Wood D. A comparison of three methods of wound closure following arthroplasty: a prospective, randomised, controlled trial. J Bone Joint Surg Br. 2006;88-B(2):238-242. PubMed
- Mastud K, Lamture Y, Nagtode T, Rewale V. A comparative study between conventional sutures, staples, and adhesive glue for clean elective surgical skin closure. Cureus. 2022;14(11):e31196. PubMed
- Smith TO, Sexton D, Mann C, Donell S. Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis. BMJ. 2010;340:c1199. PubMed
- American Academy of Orthopaedic Surgeons. Activities After Total Hip Replacement. OrthoInfo. orthoinfo.org
