Effect of the knee position during wound closure after total knee arthroplasty on early knee function recovery

Journal of Orthopaedic Surgery and Research

Gangyong Huang¹  Jianguo Wu¹  Yibin Wei¹  Jun Xia¹  Siqun Wang¹ 

[1] Department of Orthopaedics, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China

关键词: Total knee arthroplasty;    Wound closure;    Range of motion;    Anterior knee pain;   

Others  :  1152018
DOI  :  10.1186/s13018-014-0079-2

 received in 2014-02-06, accepted in 2014-08-11,  发布年份 2014

【 摘 要 】

Objective

This study investigated the effect of the knee position during wound closure on early knee function recovery after total knee arthroplasty (TKA).

Methods

This study included 80 primary total knee arthroplasties due to osteoarthritis. The patients were randomized according to the type of wound closure: extension group for full extension and flexion group for 90° flexion. The incision of articular capsule was marked for precise wound alignment. In the flexion group, the knee was kept in high flexion for 1 to 2 min after wound closure. The two groups were treated with the same postoperative rehabilitation exercises. The range of motion (ROM), visual analogue scale (VAS) score of anterior knee pain, Knee Society Score (KSS) and postoperative complications were assessed at 6 weeks, 3 months and 6 months, postoperatively.

Results

At 6 weeks and 3 months postoperatively, the ROM in flexion group was 98.95 ± 10.33° and 110.05 ± 4.93° respectively, with 87.62 ± 8.92° and 95.62 ± 6.51° in extension group, respectively; The VAS score of anterior knee pain in flexion group was 2.02 ± 1.38 and 2.21 ± 0.87, respectively, with 2.57 ± 1.07 and 2.87 ± 0.83 in extension group, respectively. The ROM and VAS pain score of the two groups were significantly different at these two time points, with no significant difference at 6 months postoperatively. The two groups were not significantly different in KSS, and no apparent complication was observed at three time points.

Conclusion

Marking the articular capsule incision, wound closure in flexion and high flexion after wound closure can effectively decrease anterior knee pain after TKA and promote the early recovery of ROM.

【 授权许可】

   
2014 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA: Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 1993, 75:950-955.
• [2]Popovic N, Lemaire R: Anterior knee pain with a posterior-stabilized mobile-bearing knee prosthesis: the effect of femoral component design. J Arthroplasty 2003, 18:396-400.
• [3]Burnett RS, Boone JL, Rosenzweig SD, Steger-May K, Barrack RL: Patellar resurfacing compared with non resurfacing in total knee arthroplasty: a concise follow-up of a randomized trial. J Bone Joint Surg Am 2009, 91-A:2562-2567.
• [4]Salmon P, Hall GM, Peerbhoy D, Shenkin A, Parker C: Recovery from hip and knee arthroplasty: patients’ perspective on pain, function, quality of life, and well-being up to 6 months postoperatively. Arch Phys Med Rehabil 2001, 82:360-366.
• [5]Breugem SJ, Sierevelt IN, Schafroth MU, Blankevoort L, Schaap GR, van Dijk CN: Less anterior knee pain with a mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop 2008, 466:1959-1965.
• [6]Lehner B, Koeck FX, Capellino S, Schubert TE, Hofbauer R, Straub RH: Preponderance of sensory versus sympathetic nerve fibres and increased cellularity in the infrapatellar fat pad in anterior knee pain patients after primary arthroplasty. J Orthop Res 2008, 26:342-350.
• [7]King TV, Kish G, Eberhart RE, Holzaepfel JL: The genuflex skin closure for total knee arthroplasty. Orthopedics 1992, 15:1057-1058.
• [8]Smith TO, Davies L, Hing CB: Wound closure in flexion versus extension following total knee arthroplasty: a systematic review. Acta Orthop Belg 2010, 76:298-306.
• [9]Emerson RH Jr, Ayers C, Higgins LL: Surgical closing in total knee arthroplasty. A series follow up. Clin Orthop Relat Res 1999, 368:176-181.
• [10]Masri BA, Laskin RS, Windsor RE, Haas SB: Knee closure in total knee replacement: a randomized prospective trial. Clin Orthop 1996, 331:81-86.
• [11]Parvataneni HK, Shah VP, Howard H, Cole N, Ranawat AS, Ranawat CS: Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections. J Arthroplasty 2007, 22:33-37.
• [12]Altay MA, Ertürk C, Altay N, Akmeşe R, Işıkan UE: Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study. Orthop Traumatol Surg Res 2012, 98:421-425.
• [13]Waters TS, Bentley G: Patellar resurfacing in total knee arthroplasty: a prospective, randomized study. J Bone Joint Surg Am 2003, 85-A:212-217.
• [14]Calpur OU, Tan L, Gürbüz H, Moralar U, Copuroğlu C, Ozcan M: Arthroscopic mediopatellar plicaectomy and lateral retinacular release in mechanical patellofemoral disorders. Knee Surg Sports Traumatol Arthrosc 2002, 10:177-183.
• [15]Nasser E, Tarabichi S: Achieving high flexion after primary TKA. Techniques Knee Surg 2011, 10:87-94.
• [16]Dennis DA, Komistek RD, Scuderi GR, Zingde S: Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res 2007, 464:53-60.
• [17]Vince KG, Abdeen A: Wound problems in total knee arthroplasty. Clin Orthop 2006, 452:88-90.
• [18]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, 22:39-42.