title: The effect of tourniquet and knee position during wound closure after total knee arthroplasty on early recovery of range of motion: a prospective, randomized study.
abstract: BACKGROUND
  There is no consensus on the position of the knee joint while performing wound closure after total knee arthroplasty (TKA). Further, there are no studies focusing on the association between early functional outcomes and different wound closure strategies. Therefore, we investigated the effects of tourniquet and knee position during wound closure on early recovery of range of motion (ROM) after primary TKA. To our knowledge, this is the first study to evaluate the influence of both tourniquet and knee position during wound closure in primary TKA.
  
  
  METHODS
  One hundred-twenty eligible patients were consecutively enrolled in this study and randomly divided into four groups according to wound closure strategy. Wound closure was either performed with the knee in flexion at 90° or in full extension, with the combination of an inflated or deflated tourniquet. Visual analogue score (VAS), knee ROM, ROM recovery, knee society score (KSS), and wound complications were evaluated in the early postoperative period.
  
  
  RESULTS
  After the first postoperative week, ROM recovery in the group with knee in extension and inflated tourniquet was significantly lesser than the two groups with deflated tourniquets. Between the first and fourth postoperative weeks, ROM recovery in the group with knee inflection and deflated tourniquet was significantly higher than the two groups with knee in extension. After the first postoperative week, the visual analog score (VAS) for pain in the group with knee inflection and deflated tourniquet was significantly lesser than the two groups with inflated tourniquets. The differences in the outcomes between the four groups were not significant after the fourth postoperative week. The incidence of wound complications and KSS were not significantly different between the four groups.
  
  
  CONCLUSIONS
  Following TKA, wound closure with the knee in flexion and after deflating the tourniquet significantly decreased postoperative pain and promoted the recovery of ROM in the early postoperative period.
authors.affiliation: Istanbul Training and Research Hospital, 34098, Istanbul, Turkey.
authors.forename: Erhan
authors.initials: E
authors.lastname: Şükür
authors.affiliation: Istanbul Training and Research Hospital, 34098, Istanbul, Turkey. yozturkmen@gmail.com.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Öztürkmen
authors.affiliation: Metin Sabancı Baltalimanı Bone and Diseases Training and Research Hospital, Istanbul, Turkey.
authors.forename: Yunus Emre
authors.initials: YE
authors.lastname: Akman
authors.affiliation: Istanbul Training and Research Hospital, 34098, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Senel
authors.affiliation: Dicle University, Medical School, Diyarbakır, Turkey.
authors.forename: İbrahim
authors.initials: İ
authors.lastname: Azboy
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D013529:Surgical Wound Dehiscence / Q000628:therapy*; D014111:Tourniquets
keywords: Postoperative recovery; Range of motion; Total knee arthroplasty; Wound closure