Aim: Patients undergoing total knee arthroplasty (TKA) after prior knee surgery often present with multiple or intersecting scars, which increases the risk of wound complications. Staged sham incisions have been proposed to evaluate and optimize soft tissue viability, and facilitate subsequent TKA, though outcomes data remain limited. This study evaluates wound healing after staged sham incisions and subsequent progression to TKA in high-risk patients.
Methods: A retrospective cohort study was conducted of patients undergoing staged sham knee incisions prior to TKA at a single academic institution between 2017 and 2025. Inclusion criteria included planned staged sham incision before TKA and adequate follow-up. Patient demographics, comorbidities, scar characteristics, and postoperative outcomes were collected. Primary outcomes included wound healing complications following the sham incision and successful progression to TKA. Secondary outcomes included complications following TKA.
Results: 18 patients met inclusion criteria. Each demonstrated significant preexisting scar burden (mean 1.83 prior scars), with 77.8% requiring a new incision. Following the sham procedure, seven patients (38.9%) experienced delayed wound healing or dehiscence, and one patient (6%) developed a superficial infection. All were managed nonoperatively. Despite these complications, all patients achieved complete healing. All patients subsequently underwent TKA at a mean of 10 months after sham incision. No patients developed postoperative wound complications, prosthetic joint infection, or reoperation following TKA at a mean follow-up of 13.6 months.
Conclusion: Staged sham incisions are a safe and effective strategy for managing high-risk TKA patients with compromised soft tissue in the setting of complicating, preexisting scars. Delayed healing after the sham procedure does not preclude successful arthroplasty and may reflect a preconditioning effect due to the delay phenomenon. This approach may expand surgical candidacy and improve outcomes in complex arthroplasty patients.
