The effect of manual lymphatic drainage on postoperative recovery process following total knee arthroplasty

Year 2022, Volume: 3 Issue: 1, 66 - 70, 24.03.2022

Özge Vergili , İbrahim Deniz Canbeyli , Barış Kemal Özsar , Birhan Oktaş , Savaş Keskin

https://doi.org/10.47582/jompac.1077661

Cited By: 1

Abstract

Background: Knee joint has great importance on daily living activities thus gonarthrosis does affect quality of life of patients very dramatically. Total knee arthroplasty (TKA) is accepted as gold standard in order to cope with pain, deformity and instability especially in patients with gonarthrosis who are in terminal stage. Physical therapy and rehabilitation programs are known to increase the success of this surgical procedure. As edema around knee joint is one of the major postoperative complications, which prolong recovery process, it is important to use therapeutic modalities against this problem.
Objective: In this study it was aimed to evaluate the effectiveness of manual lymphatic drainage (MLD) following TKA on edema, range of motion, pain, independence of daily living activities, gait distance and knee functionality.
Material and Method: 16 patients with TKA were divided into two groups while one of them is applied standard postoperative rehabilitation procedure (exercise therapy, cryotherapy and positioning) and the other group had MLD therapy on the second and fourth days of the postoperative process for thirty minutes and in one session during the day in addition to standard protocol. On post-op 2nd, 4th, and 6th days, the volumetric changes were calculated based on a formula of Sitzia et al. for each 4 cm segment of the lower extremity, active ROM and knee posture at rest were measured by a universal goniometer, pain by using visual analog scale (VAS), walking distance by calculating total walking distance in a day, independence level in daily living activities by using Functional independence measurement (FIM) scale. In addition, Lysholm knee score was calculated on postoperative 15th day in order to evaluate functionality of knee joint.
Results: At postoperative 2nd day, 4th day and 6th day, the mean of FIM (p=0.972, p=0.575, p=0.398, respectively), active ROM (p=0.288, p=0.522, p=0.622, respectively), knee posture (p=0.870, p=0.521, p=0.445, respectively), gait distance (p=1.000, p=0.258, p=0.113, respectively), volume of the operated lower extremity (p=0.451, p=0.384, p=0.268, respectively), VAS for pain daytime (p=0.192, p=0.488, p=0.506, respectively) and night (p=0.137, p=0.562, p=0.748, respectively) were similar in both MLD and non-MLD groups. The mean of Lysholm score was 46.25±24.50 in MLD group and 61.12±17.70 in non-MLD group (p=0.186).
Conclusion: Although there is no significant difference between groups, the effectiveness of MLD can be showed in studies which will be performed with a larger sample size.

Keywords

Manual lymphatic drainage, total knee arthroplasty, physical therapy

Supporting Institution

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Project Number

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Thanks

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Manual lenfatik drenajın total diz artroplastisini takip eden toparlanma süreci üzerindeki etkisi

Abstract

Giriş: Diz ekleminin günlük yaşam aktivitelerinde büyük önemi vardır, bu nedenle gonartroz hastaların yaşam kalitesini çok dramatik bir şekilde etkiler. Total diz artroplastisi (TDA), özellikle terminal dönemdeki gonartrozlu hastalarda ağrı, deformite ve instabilite ile baş edebilmek için altın standart olarak kabul edilmektedir. Fizik tedavi ve rehabilitasyon programlarının bu cerrahi işlemin başarısını arttırdığı bilinmektedir. Diz eklemi çevresindeki ödem, iyileşme sürecini uzatan majör postoperatif komplikasyonlardan biri olduğundan, bu soruna karşı tedavi yöntemlerinin kullanılması önemlidir.
Amaç: Bu çalışmada TDA sonrası manuel lenfatik drenajın (MLD) ödem, hareket açıklığı, ağrı, günlük yaşam aktivitelerinin bağımsızlığı, yürüme mesafesi ve diz fonksiyonelliği üzerine etkinliğinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Total diz artroplastisi geçiren 16 hasta iki gruba ayrılarak bunlardan birine standart postoperatif rehabilitasyon prosedürü (egzersiz terapisi, cryoterapi ve pozisyonlama) uygulanırken diğer gruba standart protokole ek olarak, postoperatif sürecin 2. ve 4. günlerde günde bir kez 30 dakikalık MLD terapisi uygulandı. Ameliyat sonrası 2., 4. ve 6. günlerde hacimsel değişiklikler alt ekstremitenin her bir 4 cm’lik segmenti için Sitzia ve ark.’nın formülüne dayanarak hesaplandı; aktif EHA ve istirahatte diz postürü universal gonyometre ile ölçüldü; ağrı görsel analog skala (GAS) ile; yürüme mesafesi, bir gün içindeki toplam yürüme mesafesi hesaplanarak; günlük yaşam aktivitelerindeki bağımsızlık seviyesi Fonksiyonel bağımsızlık ölçeği ile değerlendirildi. Ayrıca diz ekleminin işlevselliğini değerlendirmek için postoperatif 15. günde Lysholm diz skoru hesaplandı.
Bulgular: Postoperatif 2. gün, 4. gün ve 6. gün FİM ortalaması (sırasıyla p=0.972, p=0.575, p=0.398), aktif EHA (sırasıyla p=0.288, p=0.522, p=0.622), diz postürü (sırasıyla p=0.870, p=0.521, p=0.445), yürüme mesafesi (sırasıyla p=1.000, p=0.258, p=0.113), ameliyat edilen alt ekstremite hacmi (sırasıyla p=0.451, p= 0.384, p=0.268), gün içindeki ağrıya yönelik GAS (sırasıyla p=0.192, p=0.488, p=0.506) ve gece ağrısına yönelik GAS (sırasıyla p=0.137, p=0.562, p=0.748) manuel lenfatik drenaj yapılan ve yapılmayan gruplarda benzerdi Lysholm skorunun ortalaması manuel lenfatik drenaj grubunda 46.25±24.50 ve manual lenfatik drenaj yapılmayan grupta 61.12±17.70 idi (p=0.186).
Sonuç: Gruplar arasında anlamlı bir fark olmamasına rağmen MLD’nin etkinliği daha büyük örneklemle yapılacak çalışmalarda gösterilebilir.

Keywords

Manuel lenfatik drenaj, total diz artroplastisi, fizik Tedavi

Project Number

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References

• Patil N, Lee K, Huddleston JI, Harris AH, Goodman SB. Aseptic versus septic revision total knee arthroplasty: patient satisfaction, outcome and quality of life improvement. Knee2010; 17: 200-3.
• Pichonnaz C, Bassin JP, Lecureux E. et al. Effect of manual lymphatic drainage after total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil 2016; 97: 674-82.
• O’Driscoll SW, Giori NJ. Continuous passive motion (CPM): theory and principles of clinical application. J Rehabil Res Dev 2000; 37: 179-88.
• Bizzini M, Boldt J, Munzinger U, Drobny T. [Rehabilitation guidelines after total knee arthroplasty]. Orthopade 2003; 32: 527-34.
• Bhave A. Rehabilitation after total hip and total knee arthroplasty. In: Barrack R BR, Lonner J, McCarthy J, Mont M, Rubash H., editor. Orthopedic knowledge update, hip and knee reconstruction. 3 ed. Rosemont: American Academy of Orthopaedic Surgeons; 2006. p. 295-308.
• Su EP, Perna M, Boettner F. et al. A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg Br 2012; 94: 153-6.
• Munk S, Jensen NJ, Andersen I, Kehlet H, Hansen TB. Effect of compression therapy on knee swelling and pain after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21: 388-92.
• Moretti B, Notarnicola A, Moretti L. et al. I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study. BMC Musculoskelet Disord 2012; 13: 88.
• Goats GC. Massage- the scientific basis of an ancient art: Part 2. Physiological and therapeutic effects. Br J Sports Med 1994; 28: 153-56.
• Tan IC, Maus EA, Rasmussen JC. et al. Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging. Arch Phys Med Rehabil 2011; 92: 756-64 e1.
• Züther J NS. Lymphedema management: the comprehensive guide for practitioners. 3 ed. New York: Thieme; 2013.
• RH S. Manual lymphatic drainage (MLD) according to Dr. E. Vodder. In: Földi M FE, editor. Textbook of lymphology for physicians and lymphedema therapists. 3 ed. Munich: Urban & Fischer; 2012. p. 467-84.
• F. VdB. Therapeutic effects of massage therapy. Stuttgart: Thieme; 2005.
• Haren K, Backman C, Wiberg M. Effect of manual lymph drainage as described by Vodder on oedema of the hand after fracture of the distal radius: a prospective clinical study. Scand J Plast Reconstr Surg Hand Surg 2000; 34: 367-72.
• Knygsand-Roenhoej K, Maribo T. A randomized clinical controlled study comparing the effect of modified manual edema mobilization treatment with traditional edema technique in patients with a fracture of the distal radius. J Hand Ther 2011; 24: 184-93; quiz 94.
• Kessler T, de Bruin E, Brunner F, Vienne P, Kissling R. Effect of manual lymph drainage after hindfoot operations. Physiother Res Int 2003; 8: 101-10.
• Ebert JR, Joss B, Jardine B, Wood DJ. Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty. Arch Phys Med Rehabil 2013; 94: 2103-11.
• Sitzia J. Volume measurement in lymphoedema treatment: examination of formulae. Eur J Cancer Care (Engl) 1995; 4: 11-6.
• Brosseau L, Balmer S, Tousignant M. et al. Intra- and intertester reliability and criterion validity of the parallelogram and universal goniometers for measuring maximum active knee flexion and extension of patients with knee restrictions. Arch Phys Med Rehabil 2001; 82: 396-402.
• Dodds TA, Martin DP, Stolov WC, Deyo RA. A validation of the functional independence measurement and its performance among rehabilitation inpatients. Arch Phys Med Rehabil 1993; 74: 531-36.
• Lysholm J, Tegner Y. Knee injury rating scales. Acta Orthop 2007; 78: 445-53.
• Wittlinger H WD, Wittlinger A, Wittlinger M. Vodder’s manual lymph drainage: a pratical guide. Stuttgart: Thieme; 2011.
• Rigoni S, Tagliaro L, Bau D, Scapin M. Effectiveness of two rehabilitation treatments in the modulation of inflammation during the acute phase in patients with knee prostheses and assessment of the role of the diet in determining post-surgical inflammation. J Orthop 2021; 25: 237-43.
• Fujiura T, Nagasawa H, Wakabayashi H. Effect of manual lymph drainage for up to 10 days after total knee arthroplasty: a randomized controlled trial. Physical Therapy Research 2020; 23: 39-46.