title: Transverse incision advantages for total knee arthroplasty.
abstract: BACKGROUND
  If a transverse incision can be safely used for total knee arthroplasty (TKA), decreases in scar formation, reduced injury of the infrapatellar branch of the saphenous nerve and improved kneeling motion will be observed.
  
  
  METHODS
  We evaluated 95 patients (101 knees) on whom primary TKA was performed with follow-up of more than 2 years. A longitudinal incision was used for the first 40 knees and a transverse incision for the remaining 61 knees. Operation time, blood loss, complications and Knee Society Score were evaluated. Wound lengths, widths and the Manchester Scar Scale (MSS) were measured 1 year after the surgery. Further examination evaluated sensory disturbances and whether kneeling was possible.
  
  
  RESULTS
  The complication rate in both groups was almost the same. The wound lengths measured at a 90° knee-flexed position were about 15 cm with no significant difference between the groups. The average width measured at a maximum area was significantly smaller in the transverse group than in the longitudinal group. MSS of the transverse group was also significantly lower than that of the longitudinal group. Sensory disturbance was found to be significantly smaller in the transverse group than in the longitudinal group both in subjective and objective evaluation at 1 year after surgery. When a transverse incision was used, the direction of the incision corresponded to the running direction of the saphenous nerve, and thus, we were able to reduce sensory disturbances on the distal lateral side of the knee joint. The transverse group (70.4%) performed significantly better than the longitudinal group (40.6%) at kneeling motion.
  
  
  CONCLUSIONS
  We showed that making a transverse incision is a safe method, resulting in a reduction of scar formation and less dysfunction of the infrapatellar branch of the saphenous nerve, and improvement of kneeling motion.
authors.affiliation: Department of Orthopaedic Surgery, Fukui General Hospital, 58-16-1 Egami, Fukui, Fukui, 910-8561, Japan. ojima@ka2.so-net.ne.jp
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Ojima
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Yoshimura
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Katsuo
authors.forename: Katsunori
authors.initials: K
authors.lastname: Mizuno
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Seigaku
authors.initials: S
authors.lastname: Hayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D002921:Cicatrix / Q000517:prevention & control; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies