Abstract
BackgroundEnhanced recovery programmes in total knee arthroplasty are well established. Post-operative knee swelling is common and impairs early post-operative function. The use of a short-stretch, inelastic compression bandage is hypothesised to reduce knee swelling and improve pain and early function. A study was designed to test feasibility with a view to informing a larger, future trial and to provide preliminary data.Methods/designThis is a randomised controlled feasibility study. Fifty consecutive patients selected for primary total knee arthroplasty will be enrolled in the trial. Patients with a BMI >35, latex allergy or neurological or peripheral vascular disease are excluded. Patients are randomised by distance randomisation to receive a compression bandage for 24 hours after surgery or a standard wool and crepe bandage. The bandages are applied by one of two consultant surgeons who have had training with their application. Knee swelling, range of motion and pain scores will be compared pre-operatively and at day 1, day 2 and at 6 weeks between groups. The Oxford knee score and EQ-5D health status will be compared pre-operatively and at 6 months between groups. Recruitment rates, retention rates, resource allocation, completeness of data collection, and tolerance and complications with the compression bandage are recorded. Descriptive statistics are used to calculate a standard deviation for post-operative knee swelling in the groups and to perform a power calculation incorporating anticipated patient retention rates to inform a future trial. Preliminary data will be analysed using the independent samples t-test for equal distributions and the Mann-Whitney U for unequal distributions with the significance denoted at P <0.05.DiscussionEnhanced recovery programmes have revolutionized the management of total knee arthroplasty. There is a paucity of clinical data regarding the efficacy of compression bandages. Large, randomised controlled trials are uncommon in orthopaedic surgery. The results of this study will provide feasibility and preliminary data prior to the construction of a larger, multicentre study.Trial registrationThe study was registered with Current Controlled Trials (ISRCTN86903140) on 30 May 2013.
Highlights
IntroductionPost-operative knee swelling is common and impairs early post-operative function
Enhanced recovery programmes in total knee arthroplasty are well established
Enhanced recovery programmes have revolutionized the management of total knee arthroplasty
Summary
Post-operative knee swelling is common and impairs early post-operative function. The use of a short-stretch, inelastic compression bandage is hypothesised to reduce knee swelling and improve pain and early function. The evolution of enhanced recovery programmes over the last 15 years has reduced hospital stay and morbidity, without increasing readmission rates [1,2]. Post-operative knee swelling is a common problem following total knee replacement. This is largely due to intra-articular bleeding and inflammation of periarticular tissues [3]. Knee swelling results in decreased functional performance as a result of quadriceps weakness [4] and as a result of arthrogenic reflex inhibition due to pain [5]. Excessive knee swelling is associated with increased rates of dehiscence and infection in surgical wounds [8]
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