Outcomes of Deep Wound Management Methods During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Wound closure for total knee arthroplasty (TKA) typically focuses on promoting the most optimal healing, while preventing infection, allowing for functionality and immediate ambulation, as well as providing for excellent cosmesis. We have previously described four aspects of closure for TKA including the: (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) a specific dressing. In this systematic review and meta-analysis of the literature, we will focus on closure of the deep fascial layer. Specifically, we assessed: (1) wound complication risks of different techniques; (2) closing times of different sutures; and (3) postoperative ranges of motion depending on varying levels of knee flexion or extension. There were 12 reports on wound complication risks, closing times, and positionings. The meta-analysis demonstrated overall lower wound complication risks with the use of barbed sutures (6 versus 13%, p<0.05). It also demonstrated overall significant closing time reductions with the use of barbed sutures (p<0.05). Additionally, three out of four reports showed the positive effects of closure in flexion for TKAs, while one report was inconclusive. In conclusion, this systematic review and meta-analysis demonstrated lower wound complications, decreased closing times for barbed sutures, as well as superior outcomes for closures in a semi-flexed knee position.