Total knee arthroplasty (TKA) has traditionally been performed as an effective treatment for patients with end-stage knee OA, by relieving pain, restoring function, and correcting deformity. One-leg standing (OLS) test is a widely used clinical tool to evaluate postural steadiness in a standing position for elderly people. According to previous reports, one-leg standing time was associated with subjects' age, self-assessment of their health status, body mass index, mortality, and the risk of falls. Therefore, it is important to know knee condition including OLS in older patients with knee OA. However, it is unknown whether TKA will be really beneficial for OLS in the elderly people. It was hypothesized that postoperative recovery would be more slowly in older patients than in younger patients. Our purpose was to investigate factors affecting the OLS time in patients with end-stage knee OA and to clarify an age-related recovery process following TKA in the early postoperative period. A total of 80 knees in 40 patients (35 females and 5 males) were enrolled in the current investigation. Mean age was 75 (60–82) years old. All the patients had bilateral varus deformities with radiographic OA of grade 4 severities, according to Kellgren-Lawrence grade. All the patients were divided into 2 Groups; patients older than 76 years (Group O) and younger than 75 years (Group Y). After unilateral TKA using Balanced Knee System®, posterior stabilized design (Ortho Development, Draper, UT), postoperative evaluations including OLS time, knee flexion angle during standing (KFA), and Visual Analogue Scale (VAS), were done preoperatively and daily from postoperative day 3 to 20 in each group, because epidural catheter was removed on postoperative day 2. As a statistical analysis, values of preoperative measurements were used as controls in each group. Statistical difference between the data was evaluated using two-tailed repeated-measures of analysis of variance (ANOVA). After a significant P value (< 0.05) was determined, a post hoc Dunnett test was performed to compare selected mean values, and P-values of < 0.05 was considered as significant.Introduction
Methods
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
