Dr. Aggarwal is a Board Certified and Aesthetic Laser Certified Family Physician specializing in vein disease at Vein Care Center Laser Specialists. Citing findings in the article, ““Mitigating the Post-Operative Swelling Tsunami in Total Knee Arthroplasty,” she helps explain how and why compression stockings are beneficial for reducing swelling after knee replacement surgery.
Post-operative edema from any procedure is a well-known consequence; not only to the treatment provider, but also to the patient. The stories are out there, but we finally have a study specific to knee replacement surgery, or total knee arthroplasty (TKA).
Why study TKA? Patients are seeking and needing TKAs—there were more than 1 million surgeries in 2020. Statistics estimate there will be more than 3 million procedures by 2040. With this surgery, as high as 19 percent of patients complain of post-operative dissatisfaction in relation to range of motion issues, pain, and chronic edema.
Of these concerns, let’s break down edema. What is the pathophysiology of edema? It isn’t as simple as it appears. We all know that when you poke your skin hard enough, not only does it hurt, it also creates tissue injury, followed by inflammation. The next step in this cascade is edema, which, if not controlled, leads to continued tissue compromise and potential demise. This is why early recognition of tissue damage is so important.
This pathway is well discussed as it relates to TKA in the article: “Mitigating the Post-Operative Swelling Tsunami in Total Knee Arthroplasty” by Dr. Andrew Wickline, et. al.
Obviously, TKA is more than just a poke to the skin. With so many patients requiring this surgery, we need to better understand what can happen to a patient after the procedure to help improve patient satisfaction, as well as patient outcomes.
The more prolonged and complex the procedure, the more damage the cells in the body and its structures sustain. This can result in a prolonged state of swelling. If leg edema (lymphedema, chronic venous insufficiency or lipedema) was present before the surgical procedure, the edema is typically worse post-operatively. This can elongate recovery time and potentially increase complications.
So, how can we mitigate the post-operative complexities for patients? The article beautifully lays out an action plan that patients and providers can implement to improve patient outcomes, as it relates to edema and the progression into decreased range of motion, continued pain and prolonged recovery.
First, pre-operatively, patients should be optimized for weight, tobacco cessation, incorporating an anti-inflammatory diet and medication management. In addition to these elements, patients with already present edema, hemosiderin staining, skin changes, ulcers or varicose veins should be evaluated for chronic venous insufficiency and lymphedema. Both disease entities are major contributors to post-operative complications.
Aside from grading the patient for pre-operative evaluation, patient’s edema should be addressed with compression garments prior to surgery. This can be challenging for patients, especially when range of motion is already hindering their quality of life. However, with adjustable compression garments and donning/doffing appliances, edema can be managed and improved prior to surgery.
Secondly and intra-operatively, the use of compression can be incorporated to reduce immediate swelling from a TKA. This can be done in recovery and should be discussed with your surgeon.
Post-operatively, the authors have a regimen outlined for physical therapy that includes minimum daily walking steps and other movements, including lymphatic pumps, compression garments and electrical muscle stimulation.
Too often, this undiagnosed swelling tsunami negatively impacts surgical outcomes. However, the source of the issue existed long before the incision on the skin overlying the knee was even done.
The article presents a clear outline that patients can discuss with their surgeon and incorporate before and after surgery. Read the full article online here.
Juzo offers a line of products to wear in preparation for knee replacement surgery and during recovery—including Dynamic, Move, and Wraps. View them online. As always, consult with your care team on what compression is best for you.
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