Reducing post-operative swelling following total knee arthroplasty (TKA)

Reducing post-operative swelling following total knee arthroplasty (TKA)

Total knee arthroplasty (TKA) – or total knee replacement (TKR) – is a surgical procedure for patients with osteoarthritis who have not been able to reap the benefits of conservative therapy. Although TKA is an effective and largely successful procedure, it can come with various complications that can lead to limited mobility, pain, and a reduction in the quality of life for patients.

One of the leading complications following TKA is oedema (swelling) which is reported to peak at a 35% increase in the first 6-8 days after surgery (Földi et al., 2018). Oedema occurs due to a buildup of fluid in the body’s tissue, causing inflammation. The American Academy of Orthopaedic Surgeons reports that many patients experience moderate to severe swelling for weeks post-surgery, while mild to moderate swelling can occur for up to six months after. If a patient has existing oedema before the surgery takes place, it can be exacerbated post-operatively.

Two recent studies by Yang (2023) and Wickline (2023) explore the indicators and migrators post-operative oedema in TKA patients, and how post-operative oedema can be addressed following TKA surgery, respectively.

Yang L. et al – Indicators and medical tests to identify lower limb swelling causes after total knee arthroplasty: a Delphi study with multidisciplinary experts

This study aimed to clarify the leading causes of post-operative swelling following TKA and how these can be identified through indicators and medical tests to ultimately improve patient satisfaction with the surgery.

Poor venous return was considered a leading cause for swelling after TKA, as well as the absence of lower limb muscle compression in the veins, further slowing blood flow, leading to venous stagnation, risking the development of lower limb deep vein thrombosis (DVT). Both poor venous return and DVT cause blood pooling in the veins and fluid leaking out of the tissue spaces, resulting in swelling. The quadricep muscle strength decreases significantly in the early post-operative period, requiring 2–3 years to reach the normal condition. This too can prolong post-operative swelling and lengthen the time for patients to reach a full recovery.

Through identifying these causes, it provides clinicians with a valuable reference point to diagnose and treat swelling, helping to optimise treatment and patient outcomes.

Read the study here.

Wickline A. et al – Mitigating the Post-operative Swelling Tsunami in Total Knee Arthroplasty: A Call to Action

In this manuscript, the authors explore the patient-dependent factors that can contribute to lymphatic dysfunction which may directly influence TKA postoperative recovery. A proposed peri-operative protocol is presented that focuses on identifying limb oedema/lymphoedema pre-operatively, and intra-operative technique changes that may decrease swelling post-TKA. Such techniques allow for upstream management and accelerated outcomes for pain control, decreased opioid use, improved range of motion (ROM) as well as decreasing the complications of surgical site infection (SSI), deep vein thrombosis (DVT) and limited mobility.

Post-operative measures are also outlined that can support patients with oedema reduction during their home recovery, including a low sodium diet, compression devices and bandaging, physical therapy, and a gradual increase of mobility (measured by step count).

Read the study here.

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