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Introduction <p>Peri-incisional numbness is a common but often underestimated complaint after primary total knee arthroplasty (TKA) and may negatively affect early postoperative patient satisfaction. This randomized controlled trial aimed to determine whether a modified J-shaped skin incision, created by lateralizing the distal limb of the standard midline incision by 3&#xa0;cm at the tibial tuberosity, reduces peri-incisional numbness and pain after primary TKA.</p> Materials and methods <p>Sixty-two patients undergoing primary TKA for Kellgren–Lawrence grade 4 osteoarthritis were randomized to either a standard midline incision or a modified J-shaped incision. All procedures were performed using a medial parapatellar arthrotomy and standardized perioperative protocols. The primary outcome was the area of postoperative anterior knee numbness, assessed using grid-based 10-g Semmes–Weinstein monofilament mapping at two and six&#xa0;months. Secondary outcomes included VAS pain, WOMAC, KOOS, HSS, Kujala score, range of motion, and perioperative parameters.</p> Results <p>Baseline demographic and perioperative characteristics were comparable between groups, except for longer incision length in the J-shaped group. The standard incision group had a significantly larger sensory deficit area than the J-shaped group at both two&#xa0;months and six&#xa0;months postoperatively (7.6 ± 4.2 vs. 3.5 ± 2.9&#xa0;cm.</p> <p><sup>2</sup> and 5.3 ± 3.2 vs. 2.1 ± 2.4&#xa0;cm.</p> <p><sup>2</sup>, respectively; both p &lt; 0.01). Postoperative VAS pain was significantly lower in the J-shaped group at six&#xa0;months (p = 0.048). Functional outcomes improved significantly in both groups, with no significant between-group differences.</p> Conclusions <p>The modified J-shaped skin incision significantly reduced peri-incisional numbness and early postoperative pain after primary TKA without increasing complications. This simple incision modification may improve early sensory recovery while preserving standard medial surgical exposure.</p> Trial registration <p>ClinicalTrials.gov, NCT07514598, (<a href="https://clinicaltrials.gov/study/NCT07514598">https://clinicaltrials.gov/study/NCT07514598</a>).</p>

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The effect of J-shaped incision versus standard midline incision on numbness and pain in primary total knee arthroplasty: a prospective randomized controlled trial

  • 期刊论文

  • 发表日期：

    2026年6月26日

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  • Hamit Çağlayan Kahraman,
  • Bekir Eray Kılınç,
  • Olcay Yavuz,
  • Hamza Fevzi Erdem,
  • Barış Yılmaz

摘要

Introduction

Peri-incisional numbness is a common but often underestimated complaint after primary total knee arthroplasty (TKA) and may negatively affect early postoperative patient satisfaction. This randomized controlled trial aimed to determine whether a modified J-shaped skin incision, created by lateralizing the distal limb of the standard midline incision by 3 cm at the tibial tuberosity, reduces peri-incisional numbness and pain after primary TKA.

Materials and methods

Sixty-two patients undergoing primary TKA for Kellgren–Lawrence grade 4 osteoarthritis were randomized to either a standard midline incision or a modified J-shaped incision. All procedures were performed using a medial parapatellar arthrotomy and standardized perioperative protocols. The primary outcome was the area of postoperative anterior knee numbness, assessed using grid-based 10-g Semmes–Weinstein monofilament mapping at two and six months. Secondary outcomes included VAS pain, WOMAC, KOOS, HSS, Kujala score, range of motion, and perioperative parameters.

Results

Baseline demographic and perioperative characteristics were comparable between groups, except for longer incision length in the J-shaped group. The standard incision group had a significantly larger sensory deficit area than the J-shaped group at both two months and six months postoperatively (7.6 ± 4.2 vs. 3.5 ± 2.9 cm.

2 and 5.3 ± 3.2 vs. 2.1 ± 2.4 cm.

2, respectively; both p < 0.01). Postoperative VAS pain was significantly lower in the J-shaped group at six months (p = 0.048). Functional outcomes improved significantly in both groups, with no significant between-group differences.

Conclusions

The modified J-shaped skin incision significantly reduced peri-incisional numbness and early postoperative pain after primary TKA without increasing complications. This simple incision modification may improve early sensory recovery while preserving standard medial surgical exposure.

Trial registration

ClinicalTrials.gov, NCT07514598, (https://clinicaltrials.gov/study/NCT07514598).