Flexion versus extension wound closure position in total knee arthroplasty: a meta-analysis
10.3760/cma.j.cn121113-20241116-00661
- VernacularTitle:膝关节屈曲与伸直位切口闭合对全膝关节置换术后疗效影响的meta分析
- Author:
Ke ZHOU
1
;
Xin ZHI
;
Jinyuan XIE
;
Ming NI
;
Guoqiang ZHANG
Author Information
1. 荆门市中心医院（荆楚理工学院附属荆门市中心医院）关节骨科，荆门 448000
- Publication Type:Journal Article
- Keywords:
Arthroplasty, replacement, knee;
Surgical wound;
Posture;
Range of motion, articular;
Evidence-based medicine
- From:
Chinese Journal of Orthopaedics
2025;45(18):1201-1207
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the impact of wound closure in knee flexion versus extension on postoperative outcomes after total knee arthroplasty (TKA).Methods:Randomized controlled trials (RCTs) comparing the effects of knee flexion versus extension wound closure on TKA outcomes were retrieved from databases including CNKI, WanFang Data, Chinese Medical Journal Full-text Database, PubMed, Medline, Cochrane Library, and Embase, from inception to October 1, 2024. Outcome measures include knee range of motion (ROM), Knee Society score (KSS), visual analogue scale (VAS), and incidence of postoperative complications at different time points. Meta-analysis was performed using Stata 18.0. The methodological quality of included RCTs was assessed using the modified Jadad scale. A fixed-effects model was applied when heterogeneity was low, while a random-effects model was used when heterogeneity was high.Results:A total of 467 patients from 7 RCTs were included (233 in flexion group, 234 in extension group). The mean age was 66.4 years in the flexion group and 66.7 years in the extension group, with a follow-up ranging from 1 to 12 months. All studies were of high quality. The meta-analysis revealed that the flexion group had significantly greater knee ROM at 1 month [ WMD=3.72, 95% CI(3.12, 4.33), P<0.001] and 3 months [ WMD=5.31, 95% CI(0.79, 9.84), P=0.020] postoperatively compared to the extension group. At 6 months postoperatively, the flexion group showed significantly higher KSS [ WMD=-1.25, 95% CI(-1.51, -0.99), P<0.001]. No significant differences were found in ROM at 6 months [ WMD=0.89, 95% CI(-0.99, 2.77), P=0.350], VAS at 3 months [ WMD=-0.28, 95% CI(-1.59, -0.03), P=0.075], or complication rates [ RD=0.03, 95% CI(-0.01,0.07), P=0.198]. Conclusion:Wound closure in knee flexion can improve early knee range of motion within 3 months and functional outcomes at 6 months after TKA.
