The distance between new and previous incisions does not affect skin necrosis in total knee arthroplasty: a parallel-randomized controlled clinical trial.

BACKGROUND: To avoid skin necrosis, an 8 cm distance between the new and previous incision is recommended in patients undergoing total knee arthroplasty (TKA). It was hypothesized that making a new incision less than 8 cm of the prior scar does not increase the risk of skin complications, and the new incision can be made anywhere, regardless of the distance from the previous scar. This study investigated how making a new incision, irrespective of the previous scars, affects skin necrosis. METHODS: In this parallel, randomized clinical trial, by simple randomization method using a random number table, 50 patients with single longitudinal knee scars were randomly assigned to two groups with a 1:1 ratio and 25 participants in each group. Patients with a minimum age of 60 and a single longitudinal previous scar on the knee were included. The exclusion criteria were diabetes mellitus, hypertension, morbid obesity, smoking, vascular disorders, cardiopulmonary disorders, immune deficiencies, dementia, and taking steroids and angiogenesis inhibitors. TKA was performed through an anterior midline incision, regardless of the location of the previous scar in the intervention group. TKA was performed with a new incision at least 8 cm distant from the old incision in the control group. Skin necrosis and scar-related complications were evaluated on the first and second days and first, second, and fourth weeks after the surgery. Knee function was assessed using the Knee Society Score (KSS) six months after the surgery. RESULTS: The baseline characteristics of the groups did not differ significantly. The average distance from the previous scar was 4.1 ± 3.2 cm in the intervention group and 10.2 ± 2.1 cm in the control group. Only one patient in the control group developed skin necrosis (P-value = 0.31). Other wound-related complications were not observed in both groups. The mean KSS was 83.2 ± 10.2 and 82.9 ± 11.1 in the intervention and control groups, respectively (P-value = 0.33). CONCLUSIONS: It is possible that in TKA patients, the new incision near a previous scar does not increase the risk of skin necrosis and other complications.

Inferior Hip Dislocation in a 60-Year-Old Man; a Case Report.

Inferior hip dislocation or luxatio erecta femoris is among the rarest hip dislocations, which has been described in limited studies. The patients usually present with their hip in flexion, abduction, and external rotation. Hip dislocation is an orthopedic emergency, and a reduction needs to be performed promptly to avoid devastating complications such as avascular necrosis. Here, we present a rare case of inferior hip dislocation in a 60-year-old man following a car-motorcycle collision. The patient presented to the emergency department with left hip flexion, abduction, external rotation, and inability to move his leg due to pain. Closed reduction under procedural sedation was attempted in the emergency department once, which was unsuccessful. The patient was then taken to the operating room for another attempt of closed reduction under general anesthesia. The patient was discharged after two days with pin traction and double crutches. After two weeks, the pin was removed, and full weight-bearing was permitted. After 12 weeks, the patient had mild pain with unusual activity and slight limping; however, imaging revealed no signs of any complications.