Skin closure methods are various in total knee arthroplasty (TKA). Subcuticular skin closure techniques, which do not require postoperative stitch removal, are considered to be useful for excellent cosmesis and patients' satisfaction. Basically, subcuticular skin closure provides the tightness and water-tight seal, which leads to loss of postoperative normal physiologic drainage. As a routine wound closure, we performed the subcuticular skin closure with use of absorbable sutures or barbed sutures without staples. According to some previous reports, subcuticular skin closure using barbed sutures resulted in worse clinical outcomes, comparing with conventional skin staples. However, little attention has been paid to the differences between conventional absorbable and barbed sutures in both capsular and subcuticular skin closures. Our purpose was to investigate the efficacy and safety of the barbed suture, comparing to conventional absorbable sutures in TKA. A total of 81 knees in 75 patients (60 females and 15 males) were enrolled in the current investigation. Mean age was 73 (58–89) years old. All the subjects underwent unilateral or staged bilateral TKA using Balanced Knee System, posterior stabilized design (Ortho Development, Draper, UT). All knees were divided into two groups, as presented in Table 1. In conventional group, capsule was repaired using interrupted number 1 braided absorbable sutures, followed by closure of subdermal layer using a 3-0 monofilament absorbable suture with inverted interrupted knots. Thereafter, subcuticular skin closure was done using 4-0 monofilament absorbable suture, followed by adhesive tape. On the other hand, in barbed suture group, 1-0 and 4-0 unidirectional barbed suture (V-Loc, Covidien, Mansfield, Massachusetts) was used for capsule and subcuticular skin closure, respectively. Drains were removed on postoperative day 2. We evaluated closure time from capsule to skin, range of motion (ROM), Hollander Wound Evaluation Score (HWES: maximum score 6/6), and complications. Postoperative ROM and HWES were evaluated on postoperative day 14. As a statistical analysis, the data was compared between groups using Mann-Whitney U-test and Fisher exact probability test. P-values of < 0.05 were considered as significant.Introduction
Methods
According to previous reports, unilateral total knee arthroplasty (TKA) would produce the asymmetric changes of lower extremity in the coronal plane in patients with bilateral knee osteoarthritis (OA). To our knowledge, little attention has been paid to the alignment changes of trunk and contralateral limb. It was hypothesized that the unilateral correction of knee deformity would affect trunk bending in the coronal plane after unilateral total knee arthroplasty. The purpose of the current study was to investigate trunk bending in the coronal plane before and after the surgery. Twenty patients (17 Females and 3 Males; mean 76 years old) with bilateral symptomatic knee osteoarthritis participated. They had radiographic bilateral OA of at least grade 3 severities according to the Kellgren-Lawrence scale. All the subjects underwent unilateral TKA using Balanced Knee System®, posterior stabilized design (Ortho Development, Draper, UT). All the subjects provided informed consent. All methods and procedures were approved by our institution's ethics committee. They were asked to step on the two scales and perform relaxed standing for five seconds, placing each foot on each scale independentlys. Thereafter, anteroposterior radiographs of the whole spine and bilateral long legs were taken with use of a vertical 35.4 × 101.7-cm film. The shoulder tilting angle was defined by the height difference between the centers of the right and left acromioclavicular joints, and the pelvic tilting angle was defined by the height difference between the centers of the right and left femoral heads. To evaluate trunk bending, the shoulder-pelvis bending angle was defined as the angle between the shoulder girdle line (Fig. 1, Line a) and the pelvic line (Fig. 1, Line b). Femorotibial angle (FTA) was also evaluated. These radiographs were taken before the surgery and on postoperative day 21. Simultaneously, knee flexion angles on TKA side, subjective pain level on TKA side and vertical knee forces (% body weight; BW) on TKA side during relaxed standing were also examined. Data evaluations were done both before and on postoperative day 21. Statistical difference between the data was evaluated using two-tailed Wilcoxon t-test. P-values of < 0.05 were considered as significant.Introduction
Methods
Length of hospital stay in Japan is 20 to 30 days, which is much longer than United States. Reasons of such differences are utilization of a national insurance system in Japan, and more than 90 % of patients are discharged to home. The purpose of the current study was to investigate inpatient recovery process during relaxed standing, and to clarify the appropriate length of hospital stay following TKA. Thirty patients (25 Females and 5 Males) with knee osteoarthritis, 67 to 84 years old (mean 75), participated. All the subjects provided informed consent and the study was approved by our institution. The subjects were asked to step on the two scales and perform relaxed standing, placing each foot on each scale independently. Evaluations were divided into two categories; subjective and objective components. Subjective component was based on pain level, and objective component consisted of vertical knee force and knee flexion angle during relaxed standing. Namely, subjective pain level on TKA side, vertical knee forces (%BW) on TKA side, and knee flexion angles (degrees) on TKA side during relaxed standing, were examined. Each evaluation was done twice. Data evaluations were done pre- and post-operatively. Postoperative evaluations were done daily from postoperative day 3 to 21. Pain level, vertical knee force, and knee flexion angle were evaluated using visual analog scale (100 mm), same type of two scales, and goniometer, respectively. Vertical knee force (%BW) was defined as the ratio of weight bearing on TKA side to body weight in our study. An average value of two trials was calculated. Values of preoperative measurements were used as controls. Statistical difference between the data was evaluated using two-tailed repeated-measures of analysis of variance. After a significant P value (< 0.05) was determined, a post hoc Bonferroni correction was performed to compare selected mean values, and P-values of < 0.05 was considered as significant.Introduction
Methods
