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Background To avoid skin necrosis, an 8 cm distance between the new and previous incision is recommended in patients undergoing total knee arthroplasty (TKA). It was hypothesized that making a new incision less than 8 cm of the prior scar does not increase the risk of skin complications, and the new incision can be made anywhere, regardless of the distance from the previous scar. This study investigated how making a new incision, irrespective of the previous scars, affects skin necrosis. Methods In this parallel, randomized clinical trial, by simple randomization method using a random number table, 50 patients with single longitudinal knee scars were randomly assigned to two groups with a 1:1 ratio and 25 participants in each group. Patients with a minimum age of 60 and a single longitudinal previous scar on the knee were included. The exclusion criteria were diabetes mellitus, hypertension, morbid obesity, smoking, vascular disorders, cardiopulmonary disorders, immune deficiencies, dementia, and taking steroids and angiogenesis inhibitors. TKA was performed through an anterior midline incision, regardless of the location of the previous scar in the intervention group. TKA was performed with a new incision at least 8 cm distant from the old incision in the control group. Skin necrosis and scar-related complications were evaluated on the first and second days and first, second, and fourth weeks after the surgery. Knee function was assessed using the Knee Society Score (KSS) six months after the surgery. Results The baseline characteristics of the groups did not differ significantly. The average distance from the previous scar was 4.1 ± 3.2 cm in the intervention group and 10.2 ± 2.1 cm in the control group. Only one patient in the control group developed skin necrosis (P-value = 0.31). Other wound-related complications were not observed in both groups. The mean KSS was 83.2 ± 10.2 and 82.9 ± 11.1 in the intervention and control groups, respectively (P-value = 0.33). Conclusions It is possible that in TKA patients, the new incision near a previous scar does not increase the risk of skin necrosis and other complications.

Background:Few studies have assessed the efficacy of temporary hemiepiphysiodesis in the treatment of genu valgum in patients with cystinosis. In the present study, the authors aimed to assess the postsurgical outcome of temporary hemiepiphysiodesis for genu valgum in patients with cystinosis. Methods:In this case series study, the inclusion criterion was the occurrence of genu valgum due to definitive diagnosis of cystinosis that was treated with temporary hemiepiphysiodesis technique. The lateral distal femoral angle (LDFA) and medial proximal tibial angle (MPTA) were measured before and 6 to 12 mo after the operation. Surgical complications also were assessed within the mean follow-up time of 40.21 ± 19.86 mo. Results:Overall, 14 patients undergoing temporary hemiepiphysiodesis due to genu valgum after cystinosis were assessed. The mean age was 10.00 ± 2.41 yr (male 35.7%, female 64.3%). Hemiepiphysiodesis led to significantly increased LDFA in both left side (from 79.64 ± 3.89 to 88.28 ± 1.26, P = 0.001) and right side (from 79.42 ± 2.59 to 89.57 ± 1.69, P = 0.001). The change in MPTA on the left side (from 88.21 ± 1.36 to 86.07 ± 1.32, P = 0.001) and right side (from 88.35 ± 2.49 to 86.42 ± 1.74, P = 0.016) also was significant. Conclusions:Temporary hemiepiphysiodesis is a reproducible, efficient, and safe approach for correction of genu valgum in patients with cystinosis with few complications in children.