From Incision to Recovery: Advances and Challenges in Wound Closure After Total Knee Arthroplasty

Total Knee Arthroplasty (TKA) is one of the most common orthopedic procedures globally, with wound closure playing a critical role in postoperative recovery and complication prevention. Despite advances, the optimal closure technique remains debated. This narrative review evaluates current wound closure techniques in TKA highlighting their biomechanical and clinical outcomes. Barbed sutures offer operative efficiency and comparable biomechanical integrity, reducing closure time and needle-stick injuries. Staples provide rapid application but are linked to higher postoperative pain and infection in contaminated wounds. Tissue adhesives yield better cosmetic outcomes but are limited in high-tension zones. Hybrid techniques combining adhesives and sutures enhance closure strength and cosmesis. Emerging technologies, including AI-driven monitoring, smart dressings, and negative pressure wound therapy show potential but lack standardized protocols and long-term validation. Biomechanical considerations such as closure in knee flexion and multilayered approaches significantly influence healing outcomes. No single closure method is universally optimal; technique selection should be individualized. Emphasis on personalized approaches integrating mechanical stability, biological compatibility, and technological advances will guide future wound care strategies in TKA. Robust comparative trials and interdisciplinary collaboration are essential to standardize protocols and improve long-term outcomes.