Abstract
BackgroundWound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events. Our purpose was to investigate and to clarify the important surgical factors affecting wound score after TKA.MethodsA total of 139 knees in 128 patients (mean 73 years) without severe comorbidity were enrolled in the present study. All primary unilateral or bilateral TKAs were done using the same skin incision line, measured resection technique, and wound closure technique using unidirectional barbed suture. In terms of the wound healing, Hollander Wound Evaluation Score (HWES) was assessed on postoperative day 14. We performed multiple regression analysis using stepwise method to identify the factors affecting HWES. Variables considered in the analysis were age, sex, body mass index (kg/m2), HbA1C (%), femorotibial angle (degrees) on plain radiographs, intraoperative patella eversion during the cutting phase of the femur and the tibia in knee flexion, intraoperative anterior translation of the tibia, patella resurfacing, surgical time (min), tourniquet time (min), length of skin incision (cm), postoperative drainage (ml), patellar height on postoperative lateral radiographs, and HWES. HWES was treated as a dependent variable, and others were as independent variables.ResultsThe average HWES was 5.0 ± 0.8 point. According to stepwise forward regression test, patella eversion during the cutting phase of the femur and the tibia in knee flexion and anterior translation of the tibia were entered in this model, while other factors were not entered. Standardized partial regression coefficient was as follows: 0.57 in anterior translation of the tibia and 0.38 in patella eversion.ConclusionsFortunately, in the present study using the unidirectional barbed suture, major wound healing problem did not occur. As to the surgical technique, intraoperative patella eversion and anterior translation of the tibia should be avoided for quality cosmesis in primary TKA.
Highlights
Wound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events
Sex, body mass index (BMI), HbA1C (%), preoperative femorotibial (FTA) angle on plain radiograph, and patellar height on postoperative lateral radiographs
According to stepwise forward regression test, intraoperative patella eversion and anterior translation of the tibia were entered in this model, while age, Sex, BMI, HbA1C, FTA, surgical time, tourniquet time, patella resurfacing, length of skin incision, and patellar height were not entered in the model (Table 3)
Summary
Wound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events. Wound condition after primary total knee arthroplasty (TKA) is important for the prevention of periprosthetic infection [1, 2]. Any delay in wound healing will cause deep infection, which leads to the arthroplasty failure. Postoperative risk factors for wound complications include tight dressings, large subcutaneous hematomas, very aggressive physiotherapy, and accelerated continuous passive motion [1, 2, 10, 11]. When patients without any risk factors undergo the primary TKA, it is unknown as to the important surgical factors affecting the wound healing using detailed wound score after primary TKA so far
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