Original research
Effect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial

Presented as a paper to Physioswiss Congress 2012, May 10–11, 2012, Geneva, Switzerland, and to French Physiotherapy Association, February 7–9, 2013, Paris, France. Also presented as a poster to World Confederation for Physical Therapy Congress, May 1–4, 2015, Singapore.
https://doi.org/10.1016/j.apmr.2016.01.006Get rights and content

Abstract

Objective

To evaluate the effects of manual lymphatic drainage (MLD) on knee swelling and the assumed consequences of swelling after total knee arthroplasty (TKA).

Setting

Primary care hospital.

Participants

Two groups of 30 patients were randomized before TKA surgery (N=60; 65% women [39]; mean age, 70.7±8.8y; weight, 77.8±11.3kg; size, 1.64±0.08m; body mass index, 29.9±4.1kg/m2).

Interventions

Participants received either 5 MLD treatments or a placebo, added to rehabilitation, in between the second day and the seventh day after surgery.

Main Outcome Measures

Swelling was measured by blinded evaluators before surgery and at second day, seventh day, and 3 months using bioimpedance spectroscopy and volume measurement. Secondary outcomes were active and passive range of motion, pain, knee function, and gait parameters.

Results

At seventh day and 3 months, no outcome was significantly different between groups, except for the knee passive flexion contracture at 3 months, which was lower and less frequent in the MLD group (−2.6°; 95% confidence interval, −5.0° to −0.21°; P=.04; absolute risk reduction, 26.6%; 95% confidence interval, 0.9%–52.3%; number needed to treat, 4). The mean pain level decreased between 5.8 and 8.2mm on the visual analog scale immediately after MLD, which was significant after 4 of 5 MLD treatments.

Conclusions

MLD treatments applied immediately after TKA surgery did not reduce swelling. It reduced pain immediately after the treatment. Further studies should investigate whether the positive effect of MLD on knee extension is replicable.

Section snippets

Methods

A prospective RCT was conducted in the Department of Orthopedic and Traumatic Surgery of the University Hospital of Lausanne. Ethical approval was granted by the local ethics committee (protocol no. 224/06), and all participants gave their written consent before enrollment. MLD, added to the standard rehabilitation protocol of the department, was compared with a placebo. Five 30-minute sessions of MLD were held for the treatment group on working days between the second day and the seventh day

Results

Sixty-five eligible patients were contacted, of whom 5 declined to participate. Two randomized groups of 30 patients were created. The Consolidated Standards of Reporting Trials flow diagram detailing the recruitment process is presented in figure 2. All exclusions were due to factors external to the study.

The sample characteristics at baseline are presented in table 1. No significant difference was found between the treatment and the control group. Similarly, no significant difference was

Interpretation of the results

This RCT aimed to evaluate the effects of MLD on knee swelling and on the consequences of swelling after TKA. No statistically significant difference was found between groups at baseline and second day.

The primary outcome, swelling, was measured using 2 measurement methods to ensure the robustness of the results. No significant effect of MLD on postsurgical knee swelling was found at seventh day and 3 months, using either the limb volume or BIS (BIS when a frequency theoretically equal to 0

Conclusions

This RCT compared the effect of MLD on swelling and on the consequences of swelling with that of a placebo. MLD demonstrated no significant effect on swelling in the early phase after TKA surgery. This result reinforces the evidence against the use of MLD for reduction in swelling in this context. Conversely, MLD decreased the frequency and magnitude of passive ROM knee flexion contractures, a problematic deficiency after TKA. A transient effect on pain was also observed, which might be useful

Suppliers

  • a.

    ImpediMed.

  • b.

    Gait Up.

  • c.

    SPSS version 18; SPSS.

  • d.

    StataCorp.

Acknowledgments

We thank the physiotherapy team of the Orthopedics and Traumatology Department of the University Hospital of Lausanne - University of Lausanne for its contribution to the study organization and implementation; Pascal Morel, BSc, from the Laboratory of Movement Analysis and Measurement, Swiss Institute of Technology of Lausanne, for his assistance in gait parameter analysis; and Céline Ancey, PT, for her contribution to the manuscript content.

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      The mapping technique is used for evaluating the patients before, during and after drainage, and assisting to identify restriction of lymph flow (Chikly, 2000, 2011). Previous studies have reported the numerous benefits of using lymphatic drainage techniques in patients with various conditions such as participants with psychological stress that increased relaxation after applied lymphatic drainage for 15 min on neck (Shim and Kim, 2014), primary and secondary lymphedema that decreased fluid level and increased softening of soft tissue (Harris and Piller, 2003), chronic venous insufficiency that improved venous edema, heaviness and fatigue after received lymphatic drainage 10 session during a month (dos Santos Crisóstomo, Costa, Martins, Fernandes, & Armada-da-Silva, 2015), and after total knee arthroplasty that pain reduced immediately after applied lymphatic drainage and improved knee extension at 3 months resulting in muscles relaxation (Claude Pichonnaz et al., 2016). The success of using LDT was discussed and claimed that it had various benefits.

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    Supported by the Swiss National Science Foundation (grant no. 120298).

    Clinical Trial Registration No.: NCT00711711.

    Disclosures: none.

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