The Role of Superficial Skin Closure Technique on Postoperative Wound Healing Following Total Knee Arthroplasty: A Literature Review
Kristen Tamsil, Anna Delay, Janae Rasmussen*, Shantanu Amin, Faaiz Ibrahim and Carla Polanco
ABSTRACT
Total knee arthroplasty (TKA) is one of the most commonly performed orthopaedic procedures worldwide, offering substantial improvements in pain relief and mobility for patients with advanced knee osteoarthritis. Despite advancements in implant design and surgical technique, superficial wound complications remain a significant concern. These include delayed healing, wound dehiscence, infection, and excessive scar formation, potentially prolonging hospital stay, and reducing patient satisfaction. While deep tissue closure and joint mechanics have been extensively studied in orthopaedics, the influence of superficial skin closure techniques on wound outcomes has received less attention. The anterior knee incision traverses a high-tension, mobile area susceptible to healing complications and scar contracture. As such, the technique of skin closure may play a more critical role in postoperative recovery than traditionally recognized.
This review examines current literature evaluating the relationship between different superficial skin closure techniques—including subcuticular sutures, staples, and tissue adhesives—and their impact on wound healing outcomes, scar quality, and early postoperative function following TKA. Evidence suggests certain closure techniques, particularly continuous subcuticular sutures, may promote better wound approximation and tissue perfusion, reduce skin tension, and yield more favorable scar profiles compared to traditional interrupted sutures or staples. Some studies also report reduced rates of wound complications and improved patient-reported outcomes with subcuticular methods. However, the majority of research has focused on cosmetic or patient satisfaction outcomes, with fewer studies linking closure technique to orthopaedic recovery metrics, such as early range of motion, infection risk, or revision surgery. The superficial closure technique may have meaningful implications for wound healing, rehabilitation, and overall success in TKA. There is a need for more focused research integrating objective scar assessment tools and correlating them with functional and surgical outcomes. Clarifying these associations could support standardized closure protocols that enhance both short-term and long-term recovery in TKA patients.
