Temperature-sensitive anti-adhesive poloxamer hydrogel decreases fascial adhesion in total knee arthroplasty: A prospective randomized controlled study

Abstract

A temperature sensitive anti-adhesive poloxamer (TAP) hydrogel has been developed to reduce post-operative adhesion. The purpose of this study was to evaluate the efficacy and safety of TAP hydrogel on fascial adhesion and clinical outcomes including range of motion, pain, and patient satisfaction after total knee arthroplasty. Sixty patients who underwent unilateral primary total knee arthroplasty for knee osteoarthritis were included and randomized to either TAP group or control group. After capsular closure, TAP hydrogel was applied on the fascial layer in 30 patients of the TAP hydrogel group, while normal saline was applied to 30 patients of the control group. The primary variable was range of motion at postoperative seven days, three months, and one year. As secondary outcomes, degree of skin fold, fascial thickness measured with ultra-sonography, postoperative pain visual analogue scale, total cumulative analgesics consumption, clinical scores, and degree of satisfaction were evaluated. There were no significant differences in range of motion after surgery between the two groups. However, the degree of suprapatellar skin folding in the TAP hydrogel group was less than that of the control group at six weeks after surgery (p = 0.041). There were no significant differences in postoperative fascial thickness, pain visual analogue scale, analgesics consumption, clinical scores, or degree of satisfaction. No surgical site complication was observed. The use of TAP hydrogel failed to enhance range of motion. However, application of TAP hydrogel on the fascial layer after capsular closure in total knee arthroplasty may decrease early postoperative fascial adhesion without any complications.