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

ABSTRACT

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.