Skip to main content
SpringerLink
Log in

Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups.

Methods

In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90°. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60° and 180°/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees.

Results

No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180°/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (−4.2 %) than in Group 1 (−23.1 %).

Conclusion

For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure.

Level of evidence

II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

TKA:

Total knee arthroplasty

IKSS:

International knee society score

PT:

Peak torque

PTA:

Peak torque angle

TW:

Total work

TWD:

Total work difference values

IMS:

Isokinetic muscle strength

IMSD:

Isokinetic muscle strength difference

SD:

Standard deviation

References

  1. Chang CH, Chen KH, Yang RS, Liu TK (2002) Muscle torques in total knee arthroplasty with subvastus and parapatellar approaches. Clin Orthop Relat Res 398:189–195

    Article  PubMed  Google Scholar 

  2. Daglar B, Gungor E, Delialioglu OM, Karakus D, Ersoz M, Tasbas BA, Bayrakci K, Gunel U (2009) Comparison of knee function after antegrade and retrograde intramedullary nailing for diaphyseal femoral fractures: results of isokinetic evaluation. J Orthop Trauma 23:640–644

    Article  PubMed  Google Scholar 

  3. Dennis DA, Komistek RD, Scuderi GR, Zingde S (2007) Factors affecting flexion after total knee arthroplasty. Clin Orthop Relat Res 464:53–60

    PubMed  Google Scholar 

  4. Emerson RH Jr, Ayers C, Head WC, Higgins LL (1996) Surgical closing in primary total knee arthroplasties: flexion versus extension. Clin Orthop Relat Res 331:74–80

    Article  PubMed  Google Scholar 

  5. Emerson RH Jr, Ayers C, Higgins LL (1999) Surgical closing in total knee arthroplasty. A series followup. Clin Orthop Relat Res 368:176–181

    PubMed  Google Scholar 

  6. Hanratty B, Bennett D, Thompson NW, Beverland DE (2011) A randomised controlled trial investigating the effect of posterior capsular stripping on knee flexion and range of motion in patients undergoing primary knee arthroplasty. Knee 18:474–479

    Article  PubMed  Google Scholar 

  7. Harvey IA, Barry K, Kirby SP, Johnson R, Elloy MA (1993) Factors affecting the range of movement of total knee arthroplasty. J Bone Joint Surg Br 75:950–955

    CAS  PubMed  Google Scholar 

  8. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

    PubMed  Google Scholar 

  9. Kellgren JH, Lawrence JS (1957) Radiological assessment of rheumatoid arthritis. Ann Rheum Dis 16:485–493

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. King TV, Kish G, Eberhart RE, Holzaepfel JL (1992) The “genuflex” skin closure for total knee arthroplasty. Orthopedics 15:1057–1058

    CAS  PubMed  Google Scholar 

  11. Li B, Wen Y, Liu D, Tian L (2012) The effect of knee position on blood loss and range of motion following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 20:594–599

    Article  PubMed  Google Scholar 

  12. Maloney WJ, Schurman DJ (1992) The effects of implant design on range of motion after total knee arthroplasty. Total condylar versus posterior stabilized total condylar designs. Clin Orthop Relat Res 278:147–152

    PubMed  Google Scholar 

  13. Masri BA, Laskin RS, Windsor RE, Haas SB (1996) Knee closure in total knee replacement: a randomized prospective trial. Clin Orthop Relat Res 331:81–86

    Article  PubMed  Google Scholar 

  14. Matsumoto T, Tsumura N, Kubo S, Shiba R, Kurosaka M, Yoshiya S (2005) Influence of hip position on knee flexion angle in patients undergoing total knee arthroplasty. J Arthroplasty 20:669–673

    Article  PubMed  Google Scholar 

  15. Ritter MA, Berend ME, Harty LD, Davis KE, Meding JB, Keating EM (2004) Predicting range of motion after revision total knee arthroplasty: clustering and log-linear regression analyses. J Arthroplasty 19:338–343

    Article  PubMed  Google Scholar 

  16. Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME (2003) Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 85:1278–1285

    PubMed  Google Scholar 

  17. Ritter MA, Lutgring JD, Davis KE, Berend ME (2008) The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty. J Bone Joint Surg Am 90:777–784

    Article  PubMed  Google Scholar 

  18. Rosene JM, Fogarty TD, Mahaffey BL (2001) Isokinetic Hamstrings: quadriceps ratios in intercollegiate Athletes. J Athl Train 36:378–383

    PubMed Central  PubMed  Google Scholar 

  19. Sancheti KH, Sancheti PK, Shyam AK, Joshi R, Patil K, Jain A (2013) Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: a prospective study. Indian J Orthop 47:50–56

    Article  PubMed Central  PubMed  Google Scholar 

  20. Shoji H, Murakami T, Murai I, Kida H, Sato Y, Kojima K, Abe T, Okudera T (1990) A follow-up study by CT and MRI in 3 cases of Japanese encephalitis. Neuroradiology 32:215–219

    Article  CAS  PubMed  Google Scholar 

  21. Smith TO, Davies L, Hing CB (2010) Wound closure in flexion versus extension following total knee arthroplasty: a systematic review. Acta Orthop Belg 76:298–306

    PubMed  Google Scholar 

  22. Sole G, Hamren J, Milosavljevic S, Nicholson H, Sullivan SJ (2007) Test-retest reliability of isokinetic knee extension and flexion. Arch Phys Med Rehabil 88:626–631

    Article  PubMed  Google Scholar 

  23. Tibesku CO, Daniilidis K, Vieth V, Skwara A, Heindel W, Fuchs-Winkelmann S (2011) Sagittal plane kinematics of fixed- and mobile-bearing total knee replacements. Knee Surg Sports Traumatol Arthrosc 19:1488–1495

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey

    Erkam Kömürcü

  2. Department of Orthopedics and Traumatology, Ankara Numune Educational and Research Hospital, Ankara, Turkey

    Halil Yalçın Yüksel & Ali Biçimoğlu

  3. Department of Physical Therapy and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital of Ministry of Health, Ankara, Turkey

    Murat Ersöz

  4. Department of Orthopedics and Traumatology, Ankara Educational and Research Hospital, Ankara, Turkey

    Cem Nuri Aktekin

  5. Department of Orthopedics and Traumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey

    Onur Hapa

  6. Department of Orthopedics and Traumatology, Faculty of Medicine, Near East University, Lefkose, Cyprus

    Levent Çelebi

  7. Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey

    Ayla Akbal

Authors
  1. Erkam Kömürcü
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Halil Yalçın Yüksel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Murat Ersöz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cem Nuri Aktekin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Onur Hapa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Levent Çelebi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ayla Akbal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ali Biçimoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erkam Kömürcü.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kömürcü, E., Yüksel, H.Y., Ersöz, M. et al. Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 22, 3067–3073 (2014). https://doi.org/10.1007/s00167-014-2896-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2896-6

Keywords

Search

Navigation