Wound condition after primary total knee arthroplasty (TKA) is important for prevention of periprosthetic infection. Any delay in wound healing will cause deep infection, which leads to the arthroplasty failure. Prevention of soft tissue problems is thus essential to achieve excellent clinical results. However, it is unknown as to the important surgical factors affecting the wound healing using detailed wound score after primary TKA so far. It was hypothesized that operative technique would affect wound healing in primary TKA. The purpose of the present study was to investigate and to clarify the important surgical factors affecting wound score after primary TKA. A total of 139 knees in 128 patients (mean 73 years) were enrolled. All primary TKAs were done by single surgeon. All patients underwent unilateral or bilateral TKA using Balanced Knee System®, posterior stabilized (PS) design (Ortho Development, Draper, UT) or Legion®, PS design (Smith and Nephew, Memphis, TN) under general and/or epidural anesthesia. Patients with immunosuppressive therapy, hypokalemia, poor nutrition (albumin < 3.4 g/dL), diverticulosis, infection elsewhere, uncontrolled diabetes mellitus (HbA1C>7.0%), obesity (Body Mass Index > 35 kg/m2), smoking, renal failure, hypothyroidism, alcohol abuse, rheumatoid arthritis, posttraumatic arthritis, and previous knee surgery were excluded. Hollander Wound Evaluation Score (HWES) was assessed on postoperative day 14. We evaluated age, sex, body mass index, HbA1C (%), preoperative femorotibial angle (FTA) on plain radiograph. In addition, intraoperative patella eversion, intraoperative anterior translation of the tibia, patella resurfacing, surgical time, tourniquet time, unidirectional barbed suture and length of skin incision were also evaluated as surgical factors. Multiple regression analysis was done using stepwise method to identify the surgical factors affecting HWES.Introduction
Methods
A longer operative time will lead to the development of any postoperative complications in total knee arthroplasty (TKA). According to previous reports, a significant increase in TKA procedure time done by novice surgeons was observed compared to high-volume surgeons. Our purpose was to investigate and to clarify the important maneuver necessary for novice surgeons to minimize a surgical time in TKA. A total of 300 knees in 248 patients, averaged 74.6 ± 8.7 years, were enrolled. All primary TKAs were done using same instruments (Balanced Knee System®, PS design, Ortho Development, Draper, UT) and same measured resection technique at 14 facilities by 25 orthopedic surgeons. Surgeons were divided into three surgeon groups (4 experts, 9 medium volume surgeons, 12 novices). All methods were approved by our institution's ethics committee. We divided the operative technique into 5 steps to make comparisons of step-by-step surgical time among surgeon groups of different levels. We defined Phase 1 as performing surgical exposure from skin incision to insertion of the intramedullary rod into the femur. Thereafter, the distal and AP surface of the femur, proximal tibia, the chamfer and PS box of the femur, and patella were resected in Phase 2. In Phase 3, a setup the trial component and a keel of the tibia were done after a confirmation of appropriate ligament balance using the spacer block. Then, a bone surface was irrigated with 2000ml of saline after the removal of the trial component. Subsequently, permanent components were fixed with use of bone cement in Phase 4. Finally, the final irrigation using 2000ml saline and wound closure were done in Phase 5. Every phase of the surgical time was recorded in each TKA. As a statistical analysis, operation data including length of skin incision, component size, operation time in each phase, and ratio of surgical time in each phase to whole surgical time, were compared using non-repeated measures of ANOVA and a post hoc Bonferroni correction. The threshold for statistical significance was set at a p value of less than 0.05.Introduction
Methods
