Abstract: Introduction: The success of a TKR depends on various factors which include appropriate choice of implant and meticulous surgical technique. A simple soft-tissue tension in the anterior knee after TKA can cause knee pain and loss of ROM. Surgical technique significantly influences joint function recovery after TKA. Research mainly focuses on flexion and extension gap balance, rotational alignment and medial and lateral collateral ligament balance. The traditional knee wound closure in extension may lead to soft-tissue misalignment, resulting in higher soft-tissue tension of the anterior knee in flexion. This condition may lead to anterior knee pain and may limit postoperative ROM recovery.
Material and Methods: This study is a prospective randomised study of 6 months duration done in Sunshine Hospital, Secunderabad, Telangana A total of 66 patients from June 2016 to November 2016 were enrolled in this study. The patients were randomized according to the type of wound closure: Extension group for full extension and Flexion group for 90° flexion. In the flexion group, the knee will be kept in high flexion for 1 to 2 min after wound closure. Age, gender, body mass index, ROM, visual analogue scale (VAS) pain score of anterior knee and Knee Society Score (KSS, American Society of Knee Surgery) were not significantly different between the two groups. Thus, extension group and flexion group were comparable.
Results: In post op evaluation VAS for anterior knee at 6th wk follow up was found to be statistically significant (p-0.004) in favour of flexion group but at 3 month follow up the difference was not found to be statistically significant (p- 0.010).In post op ROM evaluation between two groups showed higher ROM at 6th wk and 3rd month which was statistically significant with p-0.001 and 0.001 respectively. Knee society score was found to be statistically significant only at 3rd month follow up between the groups, with better score in flexion group.
Conclusion: The knee position during wound closure after TKA is not only critical but also very important for postoperative knee function recovery. Wound closure in flexion can effectively decrease anterior knee pain after TKA and promote the early recovery of ROM. This difference is more pronounced in patients with BMI >30.Furher study has to be done for 6th month and 1 yr follow up evaluation to see whether these differences will persist.
