title: No difference between wound closure in extension or flexion for range of motion following total knee arthroplasty: a randomized clinical trial.
abstract: OBJECTIVE
  Total knee arthroplasty (TKA) is one of the most common surgeries performed in orthopedics. The null hypothesis of the present study was that wound closure in extension or flexion does not have any impact on range of motion (ROM) and clinical outcome after TKA.
  
  
  METHODS
  This study was a double-blind prospective randomized clinical trial performed at Kashani Hospital. From 2011 to 2012, eligible patients were consecutively enrolled in the study and randomly assigned in two groups. Soft tissue was repaired in 90° flexion in the first group and in full extension position in the second group. The primary outcome of this study was the flexion ROM after 12 months. Secondary outcome was the knee flexion ROM that was evaluated in the first, second, and fourth week and also 6 months after TKA. The other secondary outcome was the knee society score (KSS) that was evaluated before the surgery and after 12 months.
  
  
  RESULTS
  Of the 85 eligible patients who completed the study, 44 were assigned to extension group and 41 to flexion group. There was no significant difference between demographic variables in the study (n.s). There were no significant differences in ROM between the study groups (n.s). There was no significant difference in KSS between study groups before and after the study period (n.s).
  
  
  CONCLUSIONS
  It is concluded that wound closure in flexion or extension position after TKA does not affect postoperative flexion ROM and KSS.
  
  
  METHODS
  I.
authors.affiliation: Orthopaedic Department, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Motififard
authors.affiliation: Orthopaedic Department, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Heidari
authors.affiliation: Orthopaedic Department, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. amin.nemati164@gmail.com.|Medical Students Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. amin.nemati164@gmail.com.|, Mehraeen blind alley, Shahid dehghan alley, Bazarche street, Salman Farsi street, 8158119749, Isfahan, Iran. amin.nemati164@gmail.com.
authors.forename: Amin
authors.initials: A
authors.lastname: Nemati
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; D011446:Prospective Studies; D016059:Range of Motion, Articular; D058106:Wound Closure Techniques
keywords: Extension; Flexion; Soft tissue repair; Total knee arthroplasty