Randomized Trial Investigating the Efficacy of Manual Lymphatic Drainage to Improve Early Outcome After Total Knee Arthroplasty



      To investigate the efficacy of manual lymphatic drainage (MLD) in the early postoperative period after total knee arthroplasty (TKA) to reduce edema and pain and improve knee range of motion.


      Prospective randomized controlled trial.


      Private hospital and functional rehabilitation clinic.


      Consecutive sample of patients (N=43; 53 knees) scheduled for TKA.


      MLD (vs no MLD) on days 2, 3, and 4 postoperatively. Both groups underwent conventional, concomitant physical therapy.

      Main Outcome Measures

      Clinical assessment was undertaken pre- and postoperatively prior to and after the designated postoperative MLD sessions (days 2, 3, and 4) and at 6 weeks postsurgery. This included active knee flexion and extension range of motion, lower limb girths (ankle, midpatella, thigh, and calf), and knee pain using a numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score.


      A significant group effect was observed for active knee flexion, with post hoc tests demonstrating a significantly greater active knee flexion in the MLD group when compared with the control (no MLD) group at the final measure prior to hospital discharge (day 4 postsurgery) and at 6 weeks postsurgery. There were no further group effects observed for the remaining patient-reported and functional outcomes.


      MLD in the early postoperative stages after TKA appears to improve active knee flexion up to 6 weeks postsurgery, in addition to conventional care.


      List of abbreviations:

      ADL (activities of daily living), BMI (body mass index), KOOS (Knee Injury and Osteoarthritis Outcome Score), MLD (manual lymphatic drainage), NRS (numeric rating scale), OA (osteoarthritis), ROM (range of motion), TKA (total knee arthroplasty)
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