Wound Closure in Flexion versus Extension following Total Knee Replacement: Outcomes and Complications

Abstract

Position of the knee may affect the range of movement (ROM) after a total knee replacement (TKR). It has been postulated that wound closure in extension may cause shortening of the extensor mechanism and increased tension on the soft tissues. The aim of this study was to determine effect of wound closure in TKR with the knee in flexion or extension on postoperative ROM and rehabilitation. A consecutive series of 121 patients underwent primary TKR between May 2011 and August 2012. Group A (60 patients) had wound closure in extension. Group B (61 patients) had wound closure in flexion. Baseline demographic data were compared—age, body mass index, gender, American Society of Anesthetists status, length of stay, wound healing, and ROM. Oxford Knee Score (OKS) were assessed at 6 months, 1 year, and 2 years. Fifty-two males and 69 females with average age of 68 years (32–86) underwent TKR. There were no wound complications requiring surgical intervention. One patient in each group required manipulation under anesthesia for stiffness. There was no statistical difference in ROM and OKS at the last follow-up. There was no difference in outcomes following knee closure in flexion or extension.

Keywords

total knee replacement - wound closure - range of movement

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

• References

• 1 Mohammed R, Syed S, Ahmed N. Manipulation under anaesthesia for stiffness following knee arthroplasty. Ann R Coll Surg Engl 2009; 91 (03) 220-223
• 2 Schiavone Panni A, Cerciello S, Vasso M, Tartarone M. Stiffness in total knee arthroplasty. J Orthop Traumatol 2009; 10 (03) 111-118
• 3 Bong MR, Di Cesare PE. Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 2004; 12 (03) 164-171
• 4 Fisher DA, Dierckman B, Watts MR, Davis K. Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty 2007; 22 (06) (Suppl. 02) 39-42
• 5 Gandhi R, de Beer J, Leone J, Petruccelli D, Winemaker M, Adili A. Predictive risk factors for stiff knees in total knee arthroplasty. J Arthroplasty 2006; 21 (01) 46-52
• 6 Laskin RS, Beksac B. Stiffness after total knee arthroplasty. J Arthroplasty 2004; 19 (04) (Suppl. 01) 41-46
• 7 Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg Am 1998; 80 (12) 1770-1774
• 8 Masri BA, Laskin RS, Windsor RE, Haas SB. Knee closure in total knee replacement: a randomized prospective trial. Clin Orthop Relat Res 1996; (331) 81-86
• 9 Emerson Jr RH, Ayers C, Head WC, Higgins LL. Surgical closing in primary total knee arthroplasties: flexion versus extension. Clin Orthop Relat Res 1996; (331) 74-80
• 10 Emerson Jr RH, Ayers C, Higgins LL. Surgical closing in total knee arthroplasty. A series followup. Clin Orthop Relat Res 1999; (368) 176-181
• 11 Smith TO, Davies L, Hing CB. Wound closure in flexion versus extension following total knee arthroplasty: a systematic review. Acta Orthop Belg 2010; 76 (03) 298-306
• 12 King TV, Kish G, Eberhart RE, Holzaepfel JL. The “genuflex” skin closure for total knee arthroplasty. Orthopedics 1992; 15 (09) 1057-1058
• 13 Faour M, Sodhi N, Khlopas A. , et al. Knee position during surgical wound closure in total knee arthroplasty: a review. J Knee Surg 2018; 31 (01) 6-12
• 14 Wang S, Xia J, Wei Y, Wu J, Huang G. Effect of the knee position during wound closure after total knee arthroplasty on early knee function recovery. J Orthop Surg 2014; 9: 79
• 15 Şükür E, Öztürkmen Y, Akman YE, Senel A, Azboy İ. The effect of tourniquet and knee position during wound closure after total knee arthroplasty on early recovery of range of motion: a prospective, randomized study. Arch Orthop Trauma Surg 2016; 136 (12) 1773-1780
• 16 Motififard M, Heidari M, Nemati A. No difference between wound closure in extension or flexion for range of motion following total knee arthroplasty: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2016; 24 (01) 74-78
• 17 Kömürcü E, Yüksel HY, Ersöz M. , et al. Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3067-3073