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

      Abstract

      Objective

      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.

      Design

      Prospective randomized controlled trial.

      Setting

      Private hospital and functional rehabilitation clinic.

      Participants

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

      Intervention

      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.

      Results

      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.

      Conclusions

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

      Keywords

      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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      References

        • Nicholas J.
        Rehabilitation of patients with rheumatological disorders.
        in: Bradom R. Physical medicine and rehabilitation. 2nd ed. WB Saunders, Philadelphia2000: 750-751
        • Peterson L.
        Articular cartilage injuries treated with autologous chondrocyte transplantation in the human knee.
        Acta Orthop Belg. 1996; 62: 196-200
        • Brittberg M.
        • Lindahl A.
        • Nilsson A.
        • Ohlsson C.
        • Isaksson O.
        • Peterson L.
        Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation.
        N Engl J Med. 1994; 331: 889-895
      1. Access Economics. Painful realities: the economic impact of arthritis in Australia in 2007. Arthritis Australia, Canberra2007
        • Elders M.J.
        The increasing impact of arthritis on public health.
        J Rheumatol Suppl. 2000; 60: 6-8
        • Lawrence R.C.
        • Helmick C.G.
        • Arnett F.C.
        • et al.
        Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States.
        Arthritis Rheum. 1998; 41: 778-799
        • Grotle M.
        • Garratt A.M.
        • Klokkerud M.
        • Lochting I.
        • Uhlig T.
        • Hagen K.B.
        What's in team rehabilitation care after arthroplasty for osteoarthritis? Results from a multicenter, longitudinal study assessing structure, process, and outcome.
        Phys Ther. 2010; 90: 121-131
        • Ranawat C.S.
        • Ranawat A.S.
        • Mehta A.
        Total knee arthroplasty rehabilitation protocol: what makes the difference?.
        J Arthroplasty. 2003; 18: 27-30
        • Guyton A.C.
        The lymphatic system, interstitial fluid dynamics, edema and pulmonary fluid. Textbook of medical physiology.
        Saunders, Philadelphia1986: 361-373
        • Howard S.B.
        • Krishnagiri S.
        The use of manual edema mobilization for the reduction of persistent edema in the upper limb.
        J Hand Ther. 2001; 14: 291-301
        • Vairo G.L.
        • Miller S.J.
        • McBrier N.M.
        • Buckley W.E.
        Systematic review of efficacy for manual lymphatic drainage techniques in sports medicine and rehabilitation: an evidence-based practice approach.
        J Man Manip Ther. 2009; 17: e80-e89
        • Casley-Smith J.R.
        Anatomy of the lymphatic system for physical therapy. Modern treatment for lymphoedema.
        Lymphoedema Association of Australia, Malvern1997: 25-40
        • Travell J.
        • Simons D.
        Myofascial pain and dysfunction: the trigger point manual.
        Lippincott Williams & Wilkins, Baltimore1983
        • Rice D.A.
        • McNair P.J.
        Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives.
        Semin Arthritis Rheum. 2010; 40: 250-266
        • Cheville A.L.
        • McGarvey C.L.
        • Petrek J.A.
        • Russo S.A.
        • Taylor M.E.
        • Thiadens S.R.
        Lymphedema management.
        Semin Radiat Oncol. 2003; 13: 290-301
        • Williams A.
        Manual lymphatic drainage: exploring the history and evidence base.
        Br J Community Nurs. 2010; 15: S18-S24
        • Goats G.C.
        Massage–the scientific basis of an ancient art: part 2. Physiological and therapeutic effects.
        Br J Sports Med. 1994; 28: 153-156
        • Piller N.B.
        • Harris R.
        Three case studies indicating the effectiveness of manual lymph drainage on patients with primary and secondary lymphedema using objective measuring tools.
        J Bodyw Mov Ther. 2003; 7: 205-282
        • Holey E.
        • Cook E.
        Therapeutic massage.
        WB Saunders, Philadelphia1997
        • Devers B.N.
        • Conditt M.A.
        • Jamieson M.L.
        • Driscoll M.D.
        • Noble P.C.
        • Parsley B.S.
        Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty?.
        J Arthroplasty. 2011; 26: 178-186
        • Perlman A.I.
        • Sabina A.
        • Williams A.L.
        • Njike V.Y.
        • Katz D.L.
        Massage therapy for osteoarthritis of the knee: a randomized controlled trial.
        Arch Intern Med. 2006; 166: 2533-2538
        • Eghbali M.
        • Lellahgani H.
        • Alimohammadi N.
        • Daryabeigi R.
        • Ghasempour Z.
        Study on effect of massage therapy on pain severity in orthopedic patients.
        Iran J Nurs Midwifery Res. 2010; 15: 32-36
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        2nd ed. Lawrence Erlbaum, Hillsdale1988
        • Ernst E.
        The safety of massage therapy.
        Rheumatology (Oxford). 2003; 42: 1101-1106
        • Korosec B.J.
        Manual lymphatic drainage therapy.
        Home Health Care Mang Pract. 2004; 17: 99-511
        • Wittlinger H.
        • Wittlinger D.
        • Wittlinger A.
        • Wittlinger M.
        Vodder's manual lymph drainage: a practical guide.
        Thieme, Stuttgart2011
        • Hendrickson T.
        Massage & manual therapy for orthopaedic conditions.
        2nd ed. Lippincott Williams & Wilkins, Philadelphia2009
        • Brown J.
        A clinically useful method for evaluating lymphedema.
        Clin J Oncol Nurs. 2004; 8: 35-38
        • Piller N.B.
        • Douglass J.
        Manual Lymphatic Drainage - an effective treatment for lymphoedemas.
        Journal of the Australian Association of Massage Therapists. 2004; 2: 8-13
        • Roos E.M.
        • Roos H.P.
        • Lohmander L.S.
        • Ekdahl C.
        • Beynnon B.D.
        Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure.
        J Orthop Sports Phys Ther. 1998; 28: 88-96
        • Mockford B.J.
        • Thompson N.W.
        • Humphreys P.
        • Beverland D.E.
        Does a standard outpatient physiotherapy regime improve the range of knee motion after primary total knee arthroplasty?.
        J Arthroplasty. 2008; 23: 1110-1114
        • Naylor J.M.
        • Ko V.
        • Rougellis S.
        • et al.
        Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2.
        J Eval Clin Pract. 2012; 18: 652-658
        • Anouchi Y.S.
        • McShane M.
        • Kelly Jr., F.
        • Elting J.
        • Stiehl J.
        Range of motion in total knee replacement.
        Clin Orthop Relat Res. 1996; : 87-92
        • Davies D.M.
        • Johnston D.W.
        • Beaupre L.A.
        • Lier D.A.
        Effect of adjunctive range-of-motion therapy after primary total knee arthroplasty on the use of health services after hospital discharge.
        Can J Surg. 2003; 46: 30-36
        • Dennis D.A.
        • Komistek R.D.
        • Stiehl J.B.
        • Walker S.A.
        • Dennis K.N.
        Range of motion after total knee arthroplasty: the effect of implant design and weight-bearing conditions.
        J Arthroplasty. 1998; 13: 748-752
        • Lizaur A.
        • Marco L.
        • Cebrian R.
        Preoperative factors influencing the range of movement after total knee arthroplasty for severe osteoarthritis.
        J Bone Joint Surg Br. 1997; 79: 626-629
        • Walsh M.
        • Woodhouse L.J.
        • Thomas S.G.
        • Finch E.
        Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects.
        Phys Ther. 1998; 78: 248-258
        • Harvey I.A.
        • Barry K.
        • Kirby S.P.
        • Johnson R.
        • Elloy M.A.
        Factors affecting the range of movement of total knee arthroplasty.
        J Bone Joint Surg Br. 1993; 75: 950-955
        • Maloney W.J.
        • Schurman D.J.
        The effects of implant design on range of motion after total knee arthroplasty. Total condylar versus posterior stabilized total condylar designs.
        Clin Orthop Relat Res. 1992; : 147-152
        • Menke W.
        • Schmitz B.
        • Salm S.
        Range of motion after total condylar knee arthroplasty.
        Arch Orthop Trauma Surg. 1992; 111: 280-281
        • Parsley B.S.
        • Engh G.A.
        • Dwyer K.A.
        Preoperative flexion. Does it influence postoperative flexion after posterior-cruciate-retaining total knee arthroplasty?.
        Clin Orthop Relat Res. 1992; : 204-210
        • Schurman D.J.
        • Matityahu A.
        • Goodman S.B.
        • et al.
        Prediction of postoperative knee flexion in Insall-Burstein II total knee arthroplasty.
        Clin Orthop Relat Res. 1998; : 175-184
        • Schurman D.J.
        • Parker J.N.
        • Ornstein D.
        Total condylar knee replacement. A study of factors influencing range of motion as late as two years after arthroplasty.
        J Bone Joint Surg Am. 1985; 67: 1006-1014
        • Farahini H.
        • Moghtadaei M.
        • Bagheri A.
        • Akbarian E.
        Factors influencing range of motion after total knee arthroplasty.
        Iran Red Crescent Med J. 2012; 14: 417-421
        • Ryu J.
        • Saito S.
        • Yamamoto K.
        • Sano S.
        Factors influencing the postoperative range of motion in total knee arthroplasty.
        Bull Hosp Jt Dis. 1993; 53: 35-40
        • Ritter M.A.
        • Harty L.D.
        • Davis K.E.
        • Meding J.B.
        • Berend M.E.
        Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis.
        J Bone Joint Surg Am. 2003; 85: 1278-1285