title: What are the important surgical factors affecting the wound healing after primary total knee arthroplasty?
abstract: BACKGROUND
  Wound condition after primary total knee arthroplasty (TKA) is an important issue to avoid any postoperative adverse events. Our purpose was to investigate and to clarify the important surgical factors affecting wound score after TKA.
  
  
  METHODS
  A total of 139 knees in 128 patients (mean 73 years) without severe comorbidity were enrolled in the present study. All primary unilateral or bilateral TKAs were done using the same skin incision line, measured resection technique, and wound closure technique using unidirectional barbed suture. In terms of the wound healing, Hollander Wound Evaluation Score (HWES) was assessed on postoperative day 14. We performed multiple regression analysis using stepwise method to identify the factors affecting HWES. Variables considered in the analysis were age, sex, body mass index (kg/m(2)), HbA1C (%), femorotibial angle (degrees) on plain radiographs, intraoperative patella eversion during the cutting phase of the femur and the tibia in knee flexion, intraoperative anterior translation of the tibia, patella resurfacing, surgical time (min), tourniquet time (min), length of skin incision (cm), postoperative drainage (ml), patellar height on postoperative lateral radiographs, and HWES. HWES was treated as a dependent variable, and others were as independent variables.
  
  
  RESULTS
  The average HWES was 5.0 ± 0.8 point. According to stepwise forward regression test, patella eversion during the cutting phase of the femur and the tibia in knee flexion and anterior translation of the tibia were entered in this model, while other factors were not entered. Standardized partial regression coefficient was as follows: 0.57 in anterior translation of the tibia and 0.38 in patella eversion.
  
  
  CONCLUSIONS
  Fortunately, in the present study using the unidirectional barbed suture, major wound healing problem did not occur. As to the surgical technique, intraoperative patella eversion and anterior translation of the tibia should be avoided for quality cosmesis in primary TKA.
authors.affiliation: Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. kharatoh@yahoo.co.jp.|Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadouri, Kawasakiku, Kawasaki City, Kanagawa prefecture, 210-0013, Japan. kharatoh@yahoo.co.jp.
authors.forename: Kengo
authors.initials: K
authors.lastname: Harato
authors.affiliation: Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadouri, Kawasakiku, Kawasaki City, Kanagawa prefecture, 210-0013, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanikawa
authors.affiliation: Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Morishige
authors.affiliation: Department of Orthopedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadouri, Kawasakiku, Kawasaki City, Kanagawa prefecture, 210-0013, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Kaneda
authors.affiliation: Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Niki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D010329:Patella / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology*