The effect of wound closure position in total knee arthroplasty on postoperative pain and function

Year 2019, , 510 - 514, 31.12.2019

Çağdaş Pamuk

https://doi.org/10.18663/tjcl.526983

Abstract

Aim

After total knee arthroplasty (TKA), there are publications showing the
importance of soft tissue balance in pain control and functional results. In
existing publications there is no consensus on which position should be the
insicion closed. In this study, we aimed to investigate the effect of the
incision closure in the full flexion position or in full extension position
during TKA and the effect on postoperative pain and function.

 

Materials
and Methods

A total of 61 patients who were scheduled for TKA
operation due to severe gonarthrosis were included in the study. Thirty
patients who were sutured while the knee was in the maximum flexion position in
the incision of the TKA sequence were identified as Group1, and 31 patients
sutured in the full extension position were determined as Group 2. Demographic
characteristics (age, weight, body mass index (BMI)) of the patients. preop,
postoperative 1st week, postoperative 2nd week motion range and pain scores
were compared between the groups.

Results

There was no significant difference between the groups
in terms of VAS values ​​in the preoperative period. In the 1st week
postoperative range of motion and pain scores were significantly lower in Group
1 (p <0.001). No significant difference was observed between the groups at
the 6th week.

Conclusion

There is no consensus on which position the incision
will be closed in TKA. However, in the literature and as seen in the present
study, we think that the functional results of the repairs performed in the
flexion position are better in the early period.

Keywords

Knee Replacement Arthroplasty, Range of Motion, Articular, Rehabilitation

Total diz artroplastisinde insizyon kapatılırken diz pozisyonunun, postoperatif ağrı ve fonksiyona etkisi

Abstract

Amaç

Literatürde total diz artroplastisi
(TDA) sırasında inzisyonun hangi pozisyonda kapatılması gerektiği konusunda
fikir birliği yoktur. İnsizyon bölgesindeki gerginlik, hematom oluşması aynı
zamanda ekstensör mekanizmanın uyumsuz kapatılmasının erken dönemde kötü
fonksiyonel sonuçlar doğurabileceği bildirilmiştir. Bu çalışmada TDA sırasında
dizin tam fleksiyon pozisyonunda insizyonun kapatılması ile tam ekstansiyon
pozisyonda kapatılmasının, postoperatif ağrı ve fonksiyona olan etkisini
araştırmayı amaçladık.

Gereç
ve Yöntemler

İleri derece gonartroz nedeniyle TDA
operasyonu planlanan 61 hasta çalışmaya dahil edildi. TDA sırasından insizyonu
diz maksimum fleksiyon pozisyonundayken sütüre edilen 30 hasta Grup 1 olarak,
tam ekstansiyon pozisyonunda sütüre edilen 31 hasta Grup 2 olarak belirlendi.
Gruplar arasında (1) hastaların demografik özellikleri (yaş, kilo, beden kitle
indeksi (BKİ)) (2) preop, postop 1. hafta, postop 2. hafta eklem hareket
açıklığı değerleri ve ağrı skorları karşılaştırıldı.

Bulgular

Gruplar arasında ağrı değerleri
açısından preoperatif dönemde anlamlı bir fark yoktur. Postop 1. haftada eklem
hareket açıklığı ve ağrı skorları Grup 1’de anlamlı oranda düşüktür
(p<0,001). 6. hafta incelendiğinde gruplar arasında anlamlı bir fark
görülmemektedir.

Sonuç

TDA da insizyonun hangi pozisyonda
kapatılacağı konusunda fikir birliği yoktur. Ancak literatürde ve bu çalışmada
görüldüğü gibi fleksiyon pozisyonunda gerçekleştirilen onarımların fonksiyonel
sonuçlarının erken dönemde daha iyi olduğu düşüncesindeyiz.

Keywords

Diz replasman artroplastisi, Hareket açıklığı, Eklem, Rehabilitasyon

References

• 1. Deng QF, Gu HY, Peng WY, Zhang Q, Huang ZD, Zhang C, Yu YX. Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis.Postgrad Med J. 2018; 94: 678-93
• 2. 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 82: 360–66
• 3. Kornuijt A, de Kort GJL, Das D, Lenssen AF, Van der Weegen W. Recovery of knee range of motion after total knee arthroplasty in the first postoperative weeks: poor recovery can be detected early. Musculoskelet Surg 2019; Jan 9.
• 4. Grosso MJ, Neuwirth AL, Boddapati V, Shah RP, Cooper HJ, Geller JA. decresing length of hospital stay and postoperative complications after primary total hip arthroplasty: a decade analysis from 2006 to 2016. J Arthroplasty 2019; 34: 422-25
• 5. Mears SC, Edwards PK, Barnes CL. How to decrease length of hospital stay after total knee replacement. J Surg Orthop Adv 2016; 25: 2–7
• 6. Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, Lopez- Olivo MA, Zhanq H, Landon GC, Siff SJ, Suarez-Almazor ME. Cost-effectiveness of total knee replacement: a prospective cohort study. Arthritis Care Res 2014; 66: 592–99
• 7. Schwarzkopf R, Ho J, Quinn JR, Snir N, Mukamel D. Factors influencing discharge destination after total knee arthroplasty: a database analysis. Geriatr Orthop Surg Rehabil 2016;7: 95–99
• 8. Niki Y, Takeda Y, Harato K, Suda Y. Factors affecting the achievement of Japanese-style deep knee flexion aftertotal knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design. J Orthop Sci 2015; 20:1012-18.
• 9. Ishida K, Shibanuma N, Matsumoto T, Sasaki H, Takayama K, Toda A et al. Factors affecting intraoperative kinematic patterns and flexion angles in navigated total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1741-47.
• 10. Sugitani K, Arai Y, Takamiya H, Terauchi R, Nakagawa S, Ueshima K et al. Factors affecting range of motion after total knee arthroplasty in patients with more than 120 degrees of preoperative flexion angle. Int Orthop 2015; 39: 1535-40.
• 11. Bade MJ, Kittelson JM, Kohrt WM, Stevens-Lapsley JE. Predicting functional performance and range of motion outcomes after total knee arthroplasty. Am J Phys Med Rehabil 2014; 93: 579–85
• 12. Dennis DA, Heekin RD, Clark CR, Murphy JA, O’Dell TL, Dwyer KA. Effect of implant design on knee flexion. J Arthroplast 2013; 28: 429–38
• 13. Chiu KY, Ng TP, Tang WM, Yau WM. Review article: knee flexion after total knee arthroplasty. J Orthop Surg 2002; 10:194–202
• 14. Hoogeboom TJ, van Meeteren NL, Schank K, Kim RH, Miner T, Stevens-Lapsley JE. Risk factors for delayed inpatient functional recovery after total knee arthroplasty. Biomed Res Int 2015: 167643 Epub 2015 Apr 16
• 15. King TV, Kish G, Eberhart RE, Holzaepfel JL. The ‘genuflex’ skin closure for total knee arthroplasty. Orthopedics 1992; 15: 1057–58
• 16. 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
• 17. .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
• 18. 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; 24:74–78
• 19. Komurcu E, Yuksel HY, ErsozM, Aktekin CN, Hapa O 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: 3067–73
• 20. Emerson RH Jr, Ayers C, Head WC, Higgins. Surgical closing in primary total knee arthroplasties: flexion versus extension. Clin Orthop Relat Res 1996; 331:74–80
• 21. Cerciello S, Morris BJ, Lustig S, Corona K, Visonà E, Maccauro G et al. The role of wound closure in total knee arthroplasty: a systematic review on knee position. Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3306-12.
• 22. 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: 1773-80.