Wound closure position in total knee arthroplasty: flexion versus extension—a meta-analysis of randomized controlled trials

Background

Total knee arthroplasty (TKA) is one of the most commonly used procedures in orthopedics. However, whether different would closure positions affect the clinical outcomes after TKA remains controversial. We conducted a meta-analysis of randomized controlled trials (RCT) to assess the effect of wound closure position on clinical TKA outcomes.

Methods

Embase, PubMed, and the Cochrane Library databases were systematically searched. A systematic review and meta-analysis of all RCTs were performed to prove the role of different wound closure positions on TKA.

Results

Five RCTs containing 389 patients were included. Surgical closure of 90° flexion in TKA was associated with higher post-operative range-of-motion (ROM) at post-operative 4 weeks, lower VAS post-operative pain scores 4 weeks and 3 months, better peak torque difference of flexor muscle strength at 60 and 180°/s angular velocities between the flexion and the extension groups, and better total work difference of flexor muscle strength at 180°/s angular velocity. The American Knee Society Score did not show any significant difference between two closure techniques. No complications were described in the literature review.

Conclusions

Wound closure in 90° flexion during TKA may provide better postoperative ROM, higher pain relief, preferable muscle strength improvement in short-term follow-up, and no increase in the risks of wound complications.

Level of evidence

Level II.