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Post-operative Edema Prevention

Preventing the build-up of
post-operative edema
following orthopaedic surgery

Swelling in the knee, in the acute recovery period following TKR, can impair quadriceps muscle strength and rehabilitation.1,2,3

One month after TKR, quadriceps muscle strength drops 50% to 60% of pre-operative levels, despite the initiation of rehabilitation within 48 hours after surgery.4,5

Muscle weakness, particularly in the quadriceps muscle, has profound functional consequences, especially in older individuals and can be associated with decreased gait speed, balance, stair-climbing ability, and ability to rise from a seated position, as well as an increased risk for falls.6,7

Impaired functional performance can also be associated length of stay and patient-reported outcomes8 – and the associated knee swelling is known to increase rates of wound dehiscence and infection9 and can delay rehabilitation.

Causality:

Impairments in quadriceps muscle strength are caused by edema10. Spinal reflex activity from swelling can diminish quadriceps muscle strength. Overtime, the fibres of the muscles can atrophy due to the lack of use.1

Strategies to address early quadriceps muscles weakness cause should target VMA and address the underlying edema.10

Associated geko™ benefit
NICE Guidance (MTG19) recommends use of the geko™ device for reducing the risk of DVT (Deep Vein Thrombosis) in patients for whom drugs or mechanical compression may be contraindicated or impractical.

References

  1. Stevens-Lapsley E et al. Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial. Phys Ther 2012 Feb; 92(2): 210–226. Published online 2011 Nov 17. doi: [10.2522/ptj.20110124].
  2. Pua YH. The Time Course of Knee Swelling Post Total Knee Arthroplasty and Its Associations with Quadriceps Strength and Gait Speed. J Arthroplasty. 2015 Jul;30(7):1215-9. doi: 10.1016/j.arth.2015.02.010. Epub 2015 Feb 19.
  3. Palmieri-Smith R M et al. Pain and Effusion and Quadriceps Activation and Strength. J Athl Train. 2013 Mar-Apr; 48(2): 186–191. doi: [10.4085/1062-6050-48.2.10].
  4. Milzner RL et al. Early Quadriceps Strength Loss After Total Knee Arthroplasty. The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation. J Bone Joint Surg Am. 2005 May;87(5):1047-53. https://www.ncbi.nlm.nih.gov/pubmed/15866968.
  5. Bade MJ et al. Outcomes Before and After Total Knee Arthroplasty Compared to Healthy Adults. J Orthop Sports Phys Ther. 2010 Sep;40(9):559-67. doi: 10.2519/jospt.2010.3317.
  6. Rantanen T et al. Association of Muscle Strength With Maximum Walking Speed in Disabled Older Women. Am J Phys Med Rehabil. 1998 Jul-Aug;77(4):299-305.
  7. Milzner RL et al. Quadriceps Strength and the Time Course of Functional Recovery After Total Knee Arthroplasty. J Orthop Sports Phys Ther. 2005 Jul;35(7):424-36.
  8. Brock TM et al. Short-stretch Inelastic Compression Bandage in Knee Swelling Following Total Knee Arthroplasty Study (STICKS): Study Protocol for a Randomised Controlled Feasibility Study. Trials 2015;16:87.
  9. Yu GV et al. The Jones Compression Bandage. Review and Clinical Applications. J Am Podiatr Med Assoc 2002;92:221-31.
  10. Holm B et al, Loss of Knee-Extension Strength is Related to Knee Swelling after Total Knee Arthroplasty. Arch Phys Med Rehabil. 2010 Nov;91(11):1770-6. doi: 10.1016/j. apmr.2010.07.229.

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