Wound Closure Techniques for Total Knee Arthroplasty: An Evidence-Based Review of the Literature

2018 ◽  
Vol 33 (2) ◽  
pp. 633-638 ◽  
Author(s):  
Viktor E. Krebs ◽  
Randa K. Elmallah ◽  
Anton Khlopas ◽  
Morad Chughtai ◽  
Peter M. Bonutti ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
Evidence Based ◽  
Review Of The Literature ◽  
Wound Closure Techniques ◽  
Total Knee

Wound Management following Total Knee Arthroplasty: An Updated Review

2021 ◽  
Author(s):  
Brandon H. Naylor ◽  
John M. Tarazi ◽  
Hytham S. Salem ◽  
Steven F. Harwin ◽  
Michael A. Mont
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
Standard Of Care ◽  
Wound Management ◽  
Early Ambulation ◽  
Wound Closure Techniques ◽  
Important Field ◽  
Total Knee ◽  
Traditional Approaches

AbstractOptimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.

A Comparison of Wound Closure Techniques for Total Knee Arthroplasty

2011 ◽  
Vol 26 (8) ◽  
pp. 1251-1258.e4 ◽  
Author(s):  
Mitchell D. Eggers ◽  
Li Fang ◽  
David R. Lionberger
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
Wound Closure Techniques ◽  
Total Knee

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

scholarly journals Diagnostic algorithm in septic total knee arthroplasty failure – What is evidence-based?

2021 ◽  
Vol 23 ◽  
pp. 208-215
Author(s):  
Christian Suren ◽  
Igor Lazic ◽  
Maximilian Stephan ◽  
Florian Walter Lenze ◽  
Florian Pohlig ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Diagnostic Algorithm ◽  
Evidence Based ◽  
Total Knee ◽  
Arthroplasty Failure

Fibrin sealant before wound closure in total knee arthroplasty reduced blood loss: a meta-analysis

2014 ◽  
Vol 23 (7) ◽  
pp. 2019-2025 ◽  
Author(s):  
Zhi-jun Li ◽  
Xin Fu ◽  
Peng Tian ◽  
Wen-xing Liu ◽  
Yao-min Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Fibrin Sealant ◽  
Wound Closure ◽  
Meta Analysis ◽  
Total Knee

scholarly journals A symmetric anchor designed barbed suture versus conventional interrupted sutures in total knee arthroplasty: A multicenter, randomized controlled trial

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096568
Author(s):  
Wei Wang ◽  
Shigui Yan ◽  
Feng Liu ◽  
Wei Chai ◽  
Jianlin Zuo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Wound Closure ◽  
Controlled Trial ◽  
Barbed Suture ◽  
Surgical Incision ◽  
Randomized Controlled ◽  
Closure Time ◽  
Total Knee

Objective: This randomized controlled study was designed to compare the wound closure efficacy and safety of barbed suture in comparison to the conventional interrupted suture for total knee arthroplasty (TKA). Methods: This multicenter, single-blind, randomized controlled trial enrolled 184 patients who underwent elective TKA between June 2017 and April 2018. The subjects were randomized between two groups. Surgical incision closure time was considered as the primary end point. Results: A total of 184 patients participated in this randomized controlled trial; 91 patients had wound closure that involved barbed suture and 93 patients underwent conventional treatment—that is interrupted suturing with nonbarbed sutures. The surgical incision closure time was shorter ( p < 0.0001) in the barbed suture group compared with the control group (15.5 ± 4.88 vs. 20.9 ± 6.30 min). However, both groups were found to be equal in terms of the rate of postoperative complications. Conclusion: Usage of the symmetric anchor designed barbed suture is safe, efficacious, and demonstrates a decrease in surgical incision closure time in patients undergoing TKA compared to interrupted closure using conventional sutures. Future studies are warranted to demonstrate clinical and economic benefits of barbed sutures.

Tourniquet Use in Total Knee Arthroplasty

2019 ◽  
Vol 32 (08) ◽  
pp. 719-729 ◽  
Author(s):  
Jaymeson R. Arthur ◽  
Mark J. Spangehl
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Wound Complications ◽  
Evidence Based ◽  
Increased Risk ◽  
Negative Effect ◽  
Total Knee ◽  
Controversial Topic ◽  
Antibiotic Delivery

AbstractTourniquet use in total knee arthroplasty has become a controversial topic. There are several benefits of its use including improved visualization, decreased blood loss, shorter operative times, and improved antibiotic delivery. Conversely, there are several significant downsides associated with tourniquet use including postoperative pain, neuromuscular injuries, wound complications, reperfusion injury, increased risk of thrombosis, patellar tracking issues, delayed rehabilitation including decreased postoperative range of motion, and its negative effect on patients with vascular disease. However, objectively, the literature does not definitively push us toward or away from the use of a tourniquet. Furthermore, several alternatives have been developed to help mitigate some of the adverse effects associated with its use. This article summarizes the evidence for and against tourniquet use and provides an evidence-based approach to help guide surgeons in their own practice.

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