title: Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study.
abstract: OBJECTIVE
  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%).
  
  
  CONCLUSIONS
  For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure.
  
  
  METHODS
  II.
authors: Department of Orthopedics and Traumatology, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey, erkakom@yahoo.com.
authors: Erkam
authors: E
authors: Kömürcü
authors: Halil Yalçın
authors: HY
authors: Yüksel
authors: Murat
authors: M
authors: Ersöz
authors: Cem Nuri
authors: CN
authors: Aktekin
authors: Onur
authors: O
authors: Hapa
authors: Levent
authors: L
authors: Çelebi
authors: Ayla
authors: A
authors: Akbal
authors: Ali
authors: A
authors: Biçimoğlu
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology; D020370:Osteoarthritis, Knee / Q000601:surgery*; D011187:Posture; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D019415:Torque