• Study reports abnormally high VTE and high bleed risk in critically ill Covid-19 patients and calls for more effective prevention strategies.
  • Clinicians at NHS hospitals are supporting the care of Covid-19 patients with the use of geko™ devices to reduce the risk of blood clots in the most at risk patients.
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Is compression bandaging following knee surgery beneficial? ….and what’s the alternative?

9th October 2020

This is a review of two recent studies that contribute to the evidence-base informing clinical decisions for the use of compression bandaging following knee arthroplasty:

  1. Should compression bandage be performed after total knee arthroplasty?
    (A meta-analysis of randomized controlled trials (RCTs) – Lui P, et al 2019).
    https://josr-online.biomedcentral.com/articles/10.1186/s13018-019-1527-9
  1. Does compression bandaging provide any benefit after primary TKA?
    (A prospective randomized controlled trial – Matthews CN, et al 2020).
    https://journals.lww.com/clinorthop/subjects/knee/fulltext/2019/01000/does_an_elastic_compression_bandage_provide_any.26.aspx

Despite excellent long-term results following total knee arthroplasty (TKA), the immediate post-operative period, and for a number of months, is often associated with swelling, pain, infection and reduced range of movement. A compression bandage is often applied following TKA to help address these complications, however, there is controversy about the application of compression bandaging due to conflicting clinical outcomes and potential compression-related complications. Both papers have explored if routine use of compression bandaging following TKA is beneficial.

Study 1 – A meta-analysis of relevant RCTs:

RCT studies included in the meta-analysis were those that compared post-operative swelling, pain, total blood loss, range of motion (ROM) and the difference between pre and post-operative blood cell count levels.

The pooled results from 7 relevant RCTs, which reported on 511 legs, showed the compression bandage group was associated with a greater post-operative pain score during ambulation at 48 h (WMD = 0.70, 95% CI 0.07 to 1.34, P = 0.03), compared with the non-compression bandage group. No statistically significant differences were found between the groups in post-operative pain scores, swelling, blood loss, ROM, or other complications (P > 0.05).

The study concludes that current evidence is unable to conclude that compression bandaging is necessary after primary TKA and that surgeons routinely undertaking compression bandaging should deliberate whether there is enough clinical evidence.

Study 2 – A prospective randomized controlled trial:

The purpose of the study was to determine whether use of a compression bandage after TKA was associated with (1) less leg swelling (primary endpoint); or (2) improved ROM, lower pain scores for worst pain and pain during physical therapy just before surgery, post-operative day (POD) 1, POD 2, and POD 28; or fewer wound complications within 90 days of surgery (secondary endpoints).

The prospective, single-centre, two-arm, parallel-group RCT was conducted on 51 patients undergoing simultaneous, bilateral, primary TKA. The pressure of the compression bandage was not recorded; consequently, it is not known if the same effects from pressure were standardized across all study participants. However, in standard practice, compression bandages are applied without pressure recordings; therefore, the same variation or lack thereof in pressure would be found in the study as in regular practice.

Results showed, post-operatively, there were no clinical differences in post-operative lower extremity swelling, whether or not a compression bandage was used. There was no difference in post-operative knee flexion ROM and extension ROM whether or not a compression bandage was used. Greater maximal post-operative pain was observed for the limb with the compression bandage than the control limb. Likewise, there was greater pain during physical therapy for the limb with the compression bandage than the limb without – and no difference was observed in 90-day wound healing complications between the limb with and the limb without the compression dressing. Click this link to see post-operative measurements table.

The study concludes that applying a compression bandage after TKA did not result in any clinical improvement in limb circumference, ROM, or pain. Based on this study, the team believe that applying a compression bandage after TKA neither benefits nor harms the patient. Thus, they no longer use compression dressings for routine primary TKA.

Heralding a paradigm shift in oedema management, and possibly removing the need for TKA post-operative compression bandaging, is the innovative geko™ device. Clinically proven to treat and prevent post-operative and trauma-based oedema, and FDA cleared for oedema reduction, the daily disposable geko™ device is also the first bioelectronic muscle pump activator of its kind to be cleared by the FDA for VTE prevention across all patients including non-surgical patients – providing adjunctive blood clot prevention to at-risk TKA patients, along-side oedema reduction.

About the geko™ device

The size of a small wrist-watch, the geko™ device is battery powered, disposable, neuromuscular electro-stimulation therapy that is applied non-invasively to the skin over the common peroneal nerve at the side of the knee. It gently stimulates the nerve, once every second, activating the calf and foot muscle pumps resulting in increased blood flow in the deep veins of the calf, at rate equal to 60% of walking without the patient having to move.

Applied immediately post-surgery, to the operated leg, the short tail electrode of the geko™ device is placed across the knee incision wound dressing and secured with tape, with no need for compression bandaging. The device is worn for 24 hours/day in the initial post-surgery period. Once the oedema is stabilised, the geko™ device use can be reduced to at least 8 hours per day, for 7-14 days.

Highly portable, the geko™ device is:

  • Disposable – no need to sterilise after single patient use.
  • No decontamination required – not the case with other mechanical devices.
  • Easy-to-fit – minimal training.
  • Less nurse-to-patient contact time – reduced exposure to C-19 viral load.
  • No tripping hazard – no leads or hoses.

The geko™ device has been shown to effectively prevent or treat leg oedema in the following studies:

  • Wainwright et al compared the use of the geko™, a Neuromuscular Electrical Stimulation device vs. Thromboembolic Deterrent Stockings (TEDS) post Total Hip Replacement. The study consisted of 40 patients, N=20 geko™ and N=20 for TEDS. The results showed that the TED group had significantly more oedema post-operatively compared to the geko™ device (p=0.03).
  • Wainwright et al assessed the use of the geko™ device as an adjunctive therapy to reduce oedema in patients recovering from grade I and II ankle sprains. This single-centre, pilot randomised controlled study, recruiting patients referred to physiotherapy following an ankle sprain. 22 participants presenting with oedema were randomised to one of two treatment groups: (1) the current standard of care and (2) the current standard of care plus geko. The geko™ was well tolerated and demonstrated statistically significant improvements in oedema reduction as measured by fluid displacement (P = .011).
  • Mahmood & Baker et al conducted a study to compare patients with an ankle fracture who were to undergo Open Reduction Internal Fixation (ORIF). Twenty (20) patients were compared to standard of care (bedrest, leg elevation and a backslab plaster cast) vs. those with the geko™ device. The results report 60% of patients were ready for theatre in 2 days, compared to 27% in control arm, a 122% improvement. Standard treatment = 3.66 days readiness to theatre (average) vs the geko™ device + plaster cast = 1.66 days readiness to theatre (average) (P=0.001).
  • Shahid et al reported statistical significance was reached in all parameters with the most significant differences being leg oedema (calf and thigh circumference measurement) P=0.001, in a randomized clinical trial (RCT) conducted at London Health Sciences Centre (LHSC), in London, Ontario. 221 patients who underwent kidney and kidney-pancreatic transplant were followed from post-op day 1-6. The study compared the geko™ device to standard of care using anti-thrombotic (TED) stockings and Intermittent Pneumatic Compression (IPC). Parameters measured included: leg oedema, weight gain, urine output, high femoral velocity, length of stay, patient’s satisfaction, mobility and comfort level.

Sue Davenport – VP Marketing Communications
9th October 2020