Original researchEffect of Manual Lymphatic Drainage After Total Knee Arthroplasty: A Randomized Controlled Trial
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
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ImpediMed.
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Gait Up.
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SPSS version 18; SPSS.
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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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Cited by (27)
Feasibility and initial efficacy of a multimodal swelling intervention after total knee arthroplasty: A prospective pilot study with historical controls
2022, KneeCitation Excerpt :Postoperative swelling after TKA may persist for six months or more [6,7] and is associated with pain and a cascade of functional deficits observed after surgery [8–10] including reduced strength [11], decreased range of motion, and slower walking speeds [12] over the first 90 days. Swelling after TKA is a leading cause of increased emergency department visits at 30 days post-surgery [13] and also increases risk of deep venous thrombosis (DVT), infection, and wound dehiscence [6,14–17]. Given the significant, detrimental impact associated with swelling after TKA, effective interventions are needed.
The use of manual lymphatic drainage on clinical presentation of musculoskeletal injuries: A systematic review
2021, Complementary Therapies in Clinical PracticeCitation Excerpt :Four studies [25–27,29] did not report results regarding within-group effects. Data on pain were collected in five of the eight included studies [22,25,29–31] that used MLD alone or combined with other treatment modalities. In one of them [25], a decrease in pain was significantly greater when intervention included MLD combined to other treatment modalities.
Effects of lymphatic drainage therapy on autonomic nervous system responses in healthy subjects: A single blind randomized controlled trial
2021, Journal of Bodywork and Movement TherapiesCitation Excerpt :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.
Lymphatic treatments after orthopedic surgery or injury: A systematic review
2020, Journal of Bodywork and Movement Therapies
Supported by the Swiss National Science Foundation (grant no. 120298).
Clinical Trial Registration No.: NCT00711711.
Disclosures: none.