Surgical closing in total knee arthroplasty. A series followup

The benefits of closing the surgical wound of a primary and revision total knee prosthesis with the knee in full flexion are examined. A previous study showed that surgically closing the primary knee arthroplasty with the knee in full flexion produced significantly more postoperative flexion at 6 months: 114.7 degrees compared with 108.1 degrees. Of 108 selected sequential primary knee arthroplasties, the first 52 knees were closed surgically with the leg in full knee extension, and the second 56 knees were closed in 90 degrees to 110 degrees flexion, depending on the available motion of the joint. The patients in each group were matched closely in age, weight, height, gender, and surgical technique. At all followup intervals, the flexion measurements were significantly better in the flexion closure group. At 1 year, the flexion group had 117.9 degrees and the extension group had 112.9 degrees flexion. The revision series also was a selected sequential series with 13 knees in each closure group. In the revision case, the 1-year findings were similar, with significantly more knee flexion in the flexion closure group (118.7 degrees compared with 112.7 degrees). In matched groups, flexion closure in primary and revision knee replacements significantly increased total range of motion, as seen at the 1-year followup.