title: The role of wound closure in total knee arthroplasty: a systematic review on knee position.
abstract: OBJECTIVE
  Post-operative range of motion (ROM) is one of the most important parameters to assess, following total knee arthroplasty (TKA). The aims of the present systematic review were to analyse the available literature and determine if closing the knee in flexion or extension influences post-operative ROM, clinical outcomes, and complications following TKA.
  
  
  METHODS
  A systematic review was performed using the keywords "total knee arthroplasty", "total knee replacement", and "wound closure" or "joint closure" or "extension" or "flexion" with no limit regarding the year of publication. The review was limited to the English-language articles, and each article was evaluated with a modified Coleman Methodology Score (mCMS).
  
  
  RESULTS
  Six articles met inclusion criteria. The initial cohort included 202 TKAs in the flexion group and 201 in the extension group. Three hundred and ninety-seven TKAs were evaluated with an average follow-up of 8 months. There was no statistical difference (n.s.) between the two groups in terms of the average post-operative flexion. There were no statistical differences between the two groups regarding post-operative functional scores and VAS scores (n.s.). The average mCMS was 70.9, indicating good methodological quality in the included studies.
  
  
  CONCLUSIONS
  The findings of the present review did not show any statistically significant differences in terms of post-operative flexion ROM, functional scores, or complications related to the position of the knee at the time of joint and wound closure during TKA. There is no clear advantage to either closure method based on the currently available evidence, and therefore, this choice should be based on surgeon preference.
authors.affiliation: Casa Di Cura Villa Betania, Rome, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Cerciello
authors.affiliation: The Shoulder Center of Kentucky, Lexington Clinic Orthopedics - Sports Medicine Center, Lexington, KY, USA.
authors.forename: Brent Joseph
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: Albert Trillat Center, Lyon North University Hospital, Lyon, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Lustig
authors.affiliation: Università degli Studi del Molise, Campobasso, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Corona
authors.affiliation: Ospedali Riuniti Padova Sud, ULSS 17, via Albere 30, 35043, Monselice, PD, Italy. enricovisona@icloud.com.
authors.forename: Enrico
authors.identifier: http://orcid.org/0000-0001-7074-6308
authors.initials: E
authors.lastname: Visonà
authors.affiliation: Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Maccauro
authors.affiliation: Albert Trillat Center, Lyon North University Hospital, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Neyret
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000502:physiology* / Q000601:surgery*; D056888:Patient Positioning; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D058106:Wound Closure Techniques
keywords: Joint closure; Total knee arthroplasty; Total knee replacement; Wound closure